Ecthyma Gangrenosum

A 13-year-old girl who had leukemia presented to the emergency department with fever; chills; weight loss; fatigue; and a painful, erythematous rash with a central black lesion on the upper thigh. The patient was neutropenic and had been undergoing chemotherapy for 1 week.

A biopsy of material from the lesion demonstrated necrosis and ulceration around the blood vessels and deep tissues. Blood cultures grew Pseudomonas aeruginosa, confirming the diagnosis of ecthyma gangrenosum. This condition resolved completely after a 4-week course of intravenous ceftazidime and gentamicin. The teenager was followed up as an outpatient by her pediatric oncologist.

Ecthyma gangrenosum most frequently is seen in immunocompromised persons with Pseudomonas septicemia. The characteristic round, painful lesion begins as a hemorrhagic bullous patch that quickly becomes necrotic and ulcerates; a central gray-to-black eschar is surrounded by considerable erythema. Enzymes, such as elastase and protease, that are released by P aeruginosa can cause necrotizing lesions of the skin and blood vessels, giving rise to ecthyma gangrenosum.^1,2

The standard treatment for this disorder is up to 8 weeks of intravenous antibiotic therapy.

REFERENCES:1. Secord E, Mills C, Shah B, Tunnessen WW Jr. Picture of the month. Ecthyma gangrenosum secondary to Pseudomonas aeruginosa. Am J Dis Child. 1993;147:795-796.
2. Becherel PA, Chosidow O, Berger E, et al. Granulocyte-macrophage colony-stimulating factor in the management of severe ecthyma gangrenosum related to myelodysplastic syndrome. Arch Dermatol. 1995;131:892-894.