Ecthyma gangrenosum in the periorbital region in a previously healthy immunocompetent woman without bacteremia

Sarkar, Sonali; Patra, Arnab Kumar; Mondal, Monojit

doi:10.4103/2229-5178.174326

Cited by 19 publications

(8 citation statements)

References 9 publications

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“…Ecthyma gangrenosum, classically reported in the setting of P. aeruginosa BSI in neutropenic patients, is a cutaneous vasculitis caused by bacterial invasion of the media and adventitia of the vessel wall with secondary ischemic necrosis [ 95 ]. The lesion frequently begins as painless erythematous areas with papules and/or bullae that often rapidly progress becoming painful gangrenous ulcers [ 96 ].…”

Section: Management Of P Aeruginosa Skin and Softmentioning

confidence: 99%

How to manage Pseudomonas aeruginosa infections

Bassetti

Vena

Croxatto

et al. 2018

DIC

610

489

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Infections with Pseudomonas aeruginosa have become a real concern in hospital-acquired infections, especially in critically ill and immunocompromised patients. The major problem leading to high mortality lies in the appearance of drug-resistant strains. Therefore, a vast number of approaches to develop novel anti-infectives is currently pursued. Diverse strategies range from killing (new antibiotics) to disarming (antivirulence) the pathogen. In this review, selected aspects of P. aeruginosa antimicrobial resistance and infection management will be addressed. Many studies have been performed to evaluate the risk factors for resistance and the potential consequences on mortality and attributable mortality. The review also looks at the mechanisms associated with resistance – P. aeruginosa is a pathogen presenting a large genome, and it can develop a large number of factors associated with antibiotic resistance involving almost all classes of antibiotics. Clinical approaches to patients with bacteremia, ventilator-associated pneumonia, urinary tract infections and skin soft tissue infections are discussed. Antibiotic combinations are reviewed as well as an analysis of pharmacokinetic and pharmacodynamic parameters to optimize P. aeruginosa treatment. Limitations of current therapies, the potential for alternative drugs and new therapeutic options are also discussed.

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Section: Management Of P Aeruginosa Skin and Softmentioning

confidence: 99%

How to manage Pseudomonas aeruginosa infections

Bassetti

Vena

Croxatto

et al. 2018

DIC

610

489

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“…From this infection site, P. aeruginosa presumably disseminated to the trunk and extremities. According to the literature, the most common sites for EG lesions are the perineal region (57%) and lower extremities, whereas only 6% patients develop lesions on the face or trunk [ 1 , 12 ]. Usually, the primary entry site is difficult to establish due to a multitude of skin lesions.…”

Section: Discussionmentioning

confidence: 99%

“…On his first admission, the patient was treated with antimicrobial drugs for almost six weeks. Previous case reports on EG have described a duration of antibiotic treatment between two to four weeks with favorable clinical outcomes [ 4 , 12 , 13 ]. However, three weeks after the antibiotic treatment was stopped, our patient was re-admitted to the ED with a recurrence of the typical skin lesions, which again revealed the growth of P. aeruginosa .…”

Section: Discussionmentioning

confidence: 99%

An Eschar-like souvenir from a journey to Colombia: Ecthyma gangrenosum as a differential diagnosis of tropical diseases in immunocompromised patients – a case report

et al. 2021

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Background Ecthyma gangrenosum (EG) is a cutaneous infectious disease characterized by eschar-like skin ulcers typically caused by Pseudomonas aeruginosa. Here, we report a case of relapsing EG in a patient who had returned from a trip to Colombia, thus establishing EG as an important differential diagnosis of tropical diseases, and demonstrating that even long-term antibiotic treatment can result in only partial remission of EG. Case presentation A 77-year-old man with underlying chronic lymphocytic leukemia (CLL) on ibrutinib treatment was admitted because of a superinfected mosquito bite on the left ear and multiple partially necrotic skin lesions disseminated all over the entire body five days after returning from a trip to Colombia. The initial clinical suspicion of a tropical disease (leishmaniosis, systemic mycosis, or others) could not be confirmed. During the diagnostic workup, microbiological cultures of the skin biopsies and bronchoalveolar lavage revealed Pseudomonas aeruginosa, leading to a diagnosis of EG. Initial antibiotic treatment resulted in partial remission. However, the patient had to be re-admitted due to a relapse 3–4 weeks after the first episode. Finally, the patient was successfully treated with a combined approach consisting of antibiotics, recurrent surgical incisions, and administration of immunoglobulins. Conclusions In conclusion, EG should be considered as a differential diagnosis in immunosuppressed patients presenting with eschar-like skin ulcers. A combined treatment approach seems to be the best choice to achieve clinical cure and avoid relapse.

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“…The well-recognized leasion of ecthyma gangrenosum results from perivascular bacterial invasion of the media and adventitia of arteries and veins with seconday ischemic necrosis. [2]…”

Section: Introductionmentioning

confidence: 99%

Hairy cell leukemia presenting with Ecthyma Gangrenosum- a case report

2019

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BackgroundEcthyma gangrenosum is a cutaneous infectious usually associated with P. aeruginosa. It usually develops In patients with an underlying immunodeficiency.Case presentationA 50-year old mentally disabled white male with a history of epilepsy presented with fever and a painless red macule on his right arm which rapidly progressed to a painful ulcer. Blood and lesion cultures revealed P.aeruginosa, confirming our clinical diagnosis of ecthyma gangrenosum. Subsequently an underlying immune deficit was found, namely patient was diagnosed with hairy-cell leukemia. Despite adequate antibiotics no infection control could be achieved. After treating the underlying immune deficit as well, the infection and hairy-cell leukemia resolved completely.ConclusionEcthyma gangrenosum is an important cutaneous infection to recognize, because it is it is typically associated with P.aeruginosa bacteremia. Recognizing this skin leasion should prompt empiric antimicrobial therapy including an agent with antipseudomonal activity. Furthermore, just like in our case, the presence of ecthyma gangrenosum can signal the presence of an occult immune deficit, warranting further investigation.

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Ecthyma gangrenosum in the periorbital region in a previously healthy immunocompetent woman without bacteremia

Cited by 19 publications

References 9 publications

How to manage Pseudomonas aeruginosa infections

How to manage Pseudomonas aeruginosa infections

An Eschar-like souvenir from a journey to Colombia: Ecthyma gangrenosum as a differential diagnosis of tropical diseases in immunocompromised patients – a case report

Hairy cell leukemia presenting with Ecthyma Gangrenosum- a case report

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