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ecthyma gangrenosum

Etiology: 1) Pseudomonas aeruginosa & other gram-negative rods 2) Staphylococcus aureus 3) fungi & viruses Epidemiology: 1) generally affects neutropenic patients 2) occurs in up to 28% of patients with Pseudomonas bacteremia Pathology: - skin biopsy (lesion) - perivascular hemorrhage - infiltration of neutrophils - central necrosis Clinical manifestations: 1) begins as a painless, erythematous macule - indurated plaque evolving into hemorrhagic bulla or pustule that sloughs, resulting in eschar formation - quickly develops into a large necrotic ulceration 2) erythematous halo 3) most common in axillary, groin, perianal regions, buttocks, thigh 4) signs of sepsis - hypotension * images [3] Differential diagnosis: - pyoderma gangrenosum - neutrophilic dermatosis, pathergy - Sweet syndrome - neutrophilic dermatosis, edematous red or violaceous papules & nodules (juicy) - leukemia cutis - violaceous-purpuric papules - lesions rarely ulcerate & become necrotic - calciphylaxis: ESRD, purpuric patches with surrounding indurated plaques [4] Management: - surgical debridement - ceftazidime + gentamicin (case report) [3]

Related

eschar Pseudomonas aeruginosa pyoderma gangrenosum

General

ecthyma

References

  1. Mayo Internal Medicine Board Review, 1998-99, Prakash UBS (ed) Lippincott-Raven, Philadelphia, 1998, pg 499
  2. Harrison's Principles of Internal Medicine, 14th ed. Fauci et al (eds), McGraw-Hill Inc. NY, 1998, pg 94
  3. Korte AKM, Vos JM Ecthyma Gangrenosum N Engl J Med 2017; 377:e32. December 7, 2017 PMID: 29211664 http://www.nejm.org/doi/full/10.1056/NEJMicm1702302
  4. NEJM Knowledge+ Dermatology - Vaiman M, Lazarovitch T, Heller L, Lotan G. Ecthyma gangrenosum and ecthyma-like lesions: review article. Eur J Clin Microbiol Infect Dis. 2015 Apr;34(4):633-9. PMID: 25407372 Review.