Ecthyma gangrenosum secondary to severe invasive infection caused by Escherichia coli

摘要

Ecthyma gangrenosum (EG) is known as a characteristic lesion of Pseudomoncis aeruginosa sepsis and is usually seen in immunocompromised patients.We report a case of a previously healthy 48-year-old woman. She was first observed by her primary care physician to have fever and cough and was diagnosed with pharyngotonsillitis and prescribed an oral cephalosporin (cefditoren pivoxil). As the fever persisted, six days later she returned to our hospital. At admission, she was febrile and hemodynamically unstable, with tachycardia and hypotension. Physical examination at this stage found a necrotic ulcer in the tongue. Laboratory investigations documented severe pancytopenia with almost zero neutrophilcs and hypogammaglobulinemia, and C-reactive protein was markedly increased. Chest radiograph revealed pneumonia, and CT confirmed the diagnosis. She gradually deteriorated and was admitted to the intensive care unit with septic shock and a diagnosis of pneumonia, and empiric antibiotic therapy was initiated.