Ecthyma Gangrenosum Clinical Presentation
- Author: Mina Yassaee Kingsbery, MD; Chief Editor: Dirk M Elston, MD more...
Ecthyma gangrenosum (EG) typically occurs in patients who are immunocompromised, including patients with hematologic malignancies, immunodeficiency syndromes, severe burns, malnutrition, recent chemotherapy, immunosuppressive therapy, and diabetes mellitus. While a few case reports describe the development of EG in previously healthy children, most of these patients had unrecognized risk factors for the development of EG, including intra-abdominal or appendiceal abscesses, recent viral illness such as influenza B leading to a transient severe neutropenia, or antibiotic treatment for underlying medical conditions such as hypogammaglobulinemia and neutropenia.
Two reports describe toxic epidermal necrolysis followed by EG, one in a 62-year-old woman and the other in a 3-year-old boy.[5, 6]
Breakdown of mechanical defense barriers increases susceptibility to pseudomonal or fungal infections. Pseudomonas sepsis frequently occurs after surgical procedures, especially urologic procedures. Long-term indwelling urinary catheters, long-term intravenous placements, and tracheostomies have been associated with EG.
In several reported cases, patients with EG were on prolonged antibiotic therapy targeting non-Pseudomonas organisms. This may have led to elimination of normal flora and promoted Pseudomonas overgrowth.
Children with EG may develop diarrhea (30%) before the onset of cutaneous lesions.
Patients often present with fever a few days prior to developing EG.
Primary cutaneous lesions of ecthyma gangrenosum (EG) initially appear as painless round erythematous macules that rapidly become pustular with surrounding erythema. A hemorrhagic focus appears in the center, forming a bulla. As the hemorrhagic bulla spreads peripherally, it evolves into a gangrenous ulcer with a central black/gray eschar surrounded by an erythematous halo. The transformation of an early lesion to a necrotic ulcer may occur in as little as 12 hours.
Distribution of lesions
The patient may have a single lesion or multiple lesions. EG may appear at any location on the body; however, it predominately affects the anogenital and axillary areas. Distribution occurs at the following frequencies: gluteal or perineal region (57%), extremities (30%), trunk (6%), and face (6%); bilateral periorbital manifestations are rare but have been reported.[7, 8]
Ecthyma gangrenosum (EG) is typically and most commonly caused by P aeruginosa; however, EG-like lesions have been observed in patients with other bacterial and fungal infections. Organisms that cause ecthyma and EG-like lesions include the following:
Gram-positive bacteria are as follows:
Gram-negative bacteria are as follows:
Burkholderia cepacia 
Chromobacterium violaceum 
Morganella morganii 
Fungi are as follows:
Candida albicans 
Curvularia species 
Fusarium solani 
Mucor and Rhizopus species
Pseudallescheria boydii 
Viral causes include herpes simplex virus
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