Painful red nodules of the legs: A manifestation of chronic infection with gram-negative organisms

Recurrent Serratia marcescens cutaneous infection manifesting as painful nodules and ulcers

“…6 In our case there was a rapid evolution from nodules to excavated ulcers, through spontaneous drainage of hematic content. In two recent reports, 7,9 Serratia was the cause of painful nodules with abscess formation in the leg, a clinical presentation with similarities to our case, but without the intensity of the clinical picture that occurred in our patient. In one of these reports 9 the patient had, as in our case, alcohol-induced chronic hepatic disease and venous dermatitis, which are known factors associated with complications in infectious cellulites.…”

“…3 S marcescens seems to be a rare cause of skin infections, with only a few reports in the literature, typically occurring in elderly or immunocompromised patients. [4][5][6][7][8][9][10] Clinical presentations include chronic cutaneous granulomatous lesions, 4 cellulitis, 5 necrotizing fasciitis, 10 secondary infection of leg ulcers, 5 hidradenitis, 8 and disseminated papular erosions. 6 In our case there was a rapid evolution from nodules to excavated ulcers, through spontaneous drainage of hematic content.…”

Severe and Progressive Cellulitis Caused by Serratia marcescens Following a Dog Scratch

“…Infections in patients with venous insufficiency have presented as nodules, purulent ulcers, and cellulitis. 18,20,21,28…”

“…14 Serratia skin and soft tissue infections are uncommon, and most cases occur in immunocompromised patients. Presentations include isolated plaques, 15 bullous cellulitis, 16 papillovesicular eruptions, 17 abscesses, 18,19 nodules, 20,21 granulomatous lesions, 22,23 and necrotizing cellulitis. 24 Cases have been reported in the extremities of patients with uncontrolled diabetes 25 and end-stage renal disease, 26 as well as those who have undergone splenectomy 27 and chemotherapy.…”

Acute dermal abscesses caused by Serratia marcescens

“…It can produce two patterns of infection, an acute form, consisting of cellulitis or dermal abscesses that can evolve to ulcers, 2,3 and a chronic form lasting from months to years, based on papules or nodules with an intermittent course or granulomatous lesions. [4][5][6][7][8][9] In all these patterns of infection, a wound or a toe web infection is usually identified as the portal of entry.…”