ecthyma gangrenosum
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Etiology
- Pseudomonas aeruginosa & other gram-negative rods
- Staphylococcus aureus
- fungi & viruses
Epidemiology
- generally affects neutropenic patients
- occurs in up to 28% of patients with Pseudomonas bacteremia
Pathology
- skin biopsy (lesion)
- perivascular hemorrhage
- infiltration of neutrophils
- central necrosis
Clinical manifestations
- begins as a painless, erythematous macule
- indurated plaque evolving into hemorrhagic bulla or pustule that sloughs, resulting in eschar formation
- quickly develops into a large necrotic ulceration
- erythematous halo
- most common in axillary, groin, perianal regions, buttocks, thigh
- signs of sepsis
* images[3]
Differential diagnosis
- pyoderma gangrenosum
- Sweet syndrome
- neutrophilic dermatosis, edematous red or violaceous papules & nodules (juicy)
- leukemia cutis
- violaceous-purpuric papules
- lesions rarely ulcerate & become necrotic
- calciphylaxis: ESRD, purpuric patches with surrounding indurated plaques[4]
Management
- surgical debridement
- ceftazidime + gentamicin (case report)[3]
More general terms
Additional terms
References
- ↑ Mayo Internal Medicine Board Review, 1998-99, Prakash UBS (ed) Lippincott-Raven, Philadelphia, 1998, pg 499
- ↑ Harrison's Principles of Internal Medicine, 14th ed. Fauci et al (eds), McGraw-Hill Inc. NY, 1998, pg 94
- ↑ 3.0 3.1 3.2 Korte AKM, Vos JM Ecthyma Gangrenosum N Engl J Med 2017; 377:e32. December 7, 2017 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/29211664 <Internet> http://www.nejm.org/doi/full/10.1056/NEJMicm1702302
- ↑ 4.0 4.1 NEJM Knowledge+ Dermatology
Vaiman M, Lazarovitch T, Heller L, Lotan G. Ecthyma gangrenosum and ecthyma-like lesions: review article. Eur J Clin Microbiol Infect Dis. 2015 Apr;34(4):633-9. PMID: https://www.ncbi.nlm.nih.gov/pubmed/25407372 Review.