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Clinical Images  |   April 2012
Ecthyma Gangrenosum Caused by Psedumonas aeruginosa
Author Notes
  • Address correspondence to Clare Rock, MD, University of Maryland, Department of Infectious Diseases, 725 W Lombard St, Baltimore, MD 21201-1009. E-mail: crock@umm.edu  
Article Information
Cardiovascular Disorders / Emergency Medicine / Imaging / Clinical Images
Clinical Images   |   April 2012
Ecthyma Gangrenosum Caused by Psedumonas aeruginosa
The Journal of the American Osteopathic Association, April 2012, Vol. 112, 240. doi:10.7556/jaoa.2012.112.4.240
The Journal of the American Osteopathic Association, April 2012, Vol. 112, 240. doi:10.7556/jaoa.2012.112.4.240
A 64-year-old man with acute myelogenous leukemia (absolute neutrophil count, 48/mm3) presented to the emergency department with fever (temperature, 39.3°C) and new skin lesions. The image shows a localized well-circumscribed macule with surrounding erythema and a central ulceration caused by a previous hemorrhagic bulla. Blood cultures were obtained, and empirical therapy with intravenous imipenem (1 g every 6 hours) was started. One set of blood cultures and a surface swab of the lesions grew Pseudomonas aeruginosa, consistent with the clinical diagnosis of ecthyma gangrenosum, an uncommon skin infection. Although ecthyma gangrenosum is most often associated with P aeruginosa bacteremia, it can also be seen in nonbacteremic cases.1 It is seen predominantly in immunocompromised patients.2 Perivascular bacterial invasion of the walls of arteries and veins results in nonsuppurative secondary ischemic necrosis. The patient in the present case received intravenous imipenem for 2 weeks (500 mg every 6 hours) with resolution of fever, bacteremia, and skin lesions. 
   Financial Disclosures: None reported.
 
References
Reich HL, Williams Fadeyi D, Naik NS, Honig PJ, Yan AC. Nonpseudomonal ecthyma gangrenosum. J Am Acad Dermatol. 2004;50(5 suppl):S114-S117. [CrossRef] [PubMed]
Khalil BA, Baillie CT, Kenny SEet al. Surgical strategies in the management of ecthyma gangrenosum in paediatric oncology patients. Pediatr Surg Int. 2008;24(7):793-797. [CrossRef] [PubMed]