Ecthyma gangrenosum

Synonym(s)

None

Definition

Cutaneous manifestation of Pseudomonas aeruginosa bacteremia, usually occurring in patients who are critically ill and/or immunocompromised

Pathogenesis

Caused by Pseudomonas aeruginosa, a gram negative bacterial pathogen which disseminates in patients with impaired cellular or humoral immunity or those with severe underlying illnesses such as severe burns, malnutrition, recent chemotherapy, immunosuppressive therapy, or diabetes mellitus

Clinical manifestation

Appears as edematous, well-circumscribed plaques, rapidly evolving into hemorrhagic bullae, spreading peripherally, and eventually turning into a black necrotic ulcer with an erythematous rim; commonly occurs in the gluteal or perineal region or extremities; sign of widespread dissemination of infection

Differential diagnosis

Ecthyma; herpes simplex virus infection; atypical tuberculosis; nocardiosis; sporotri-

chosis; trauma; gram negative folliculitis; pyoderma gangrenosum; septicemia from other infectious agents; cryoglobulinemia; polyarteritis nodosa; necrotizing fasciitis; vasculitis

Therapy

Initial therapy: antipseudomonal penicillin (piperacillin) with an aminoglycoside (gen-tamicin).

Subsequent therapy based on culture sensitivity

References

Khan MO, Montecalvo MA, Davis I, Wormser GP (2000) Ecthyma gangrenosum in patients with acquired immunodeficiency syndrome. Cutis 66(2):121-123

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