Ecthyma Gangrenosum: A dermatological manifestation of Pseudomonas septicimea

摘要

Ecthyma gangrenosum is a well recognized cutaneous manifestation of severe, invasive infection caused more often than not in immunocompromised and critically ill patients by Pseudomonas aeruginosa. There are isolated reports of its occurrence in normal healthy subjects and a wide range of organisms besides Pseudomonas have been implicated in its causation. It is important to recognize this association because of the unfavorable course allied with a delay in diagnosis and treatment. Case A 9 day old term male neonate of birth weight 5 kgs, delivered via lower segment cesarean section (LSCS) presented with multiple skin lesions from the 5th post natal day. Red flat lesions initially developed over the scalp with subsequent ulceration over 3-4 days. Similar lesions developed on the back, gluteal region and both lower limbs. The skin lesions were accompanied by a continuous low-grade fever. There was no history of burns, drug intake, umbilical sepsis , catheterization or diarrhea predisposing to immuno-competent status.On general examination an incision mark [figure1] was noted above the right tragus acquired during LSCS. Skin examination showed erythematous macules, papules, nodules, vesicles and well defined punched out gangrenous ulcers with raised erythematous borders and central black eschar over the scalp, back, gluteal regions and both lower limbs [figure2].