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Castater C, Bishop E, Santos A, Freedberg M, Kim P, Sciarretta C. Diabetic Soft Tissue Infections. Surg Clin North Am 2023; 103:1191-1216. [PMID: 37838463 DOI: 10.1016/j.suc.2023.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2023]
Abstract
Diabetes is a systemic illness that can cause a broad range of physiologic effects. Infection rates and wound healing are both affected through multiple mechanisms. Other physiologic changes increase risk for wounds as well as complex soft tissue infections ranging from simple cellulitis to necrotizing soft tissue infections. Clinicians and surgeons need to have a low index of suspicion for severe infection in a patient presenting with diabetes, and even more so in patients with uncontrolled diabetes.
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Affiliation(s)
- Christine Castater
- Morehouse School of Medicine, Grady Memorial Hospital 1C-144, 80 Jesse Hill Jr Drive Southeast, Atlanta, GA 30303, USA.
| | - Elliot Bishop
- Emory University, Grady Memorial Hospital Glenn Building 69 Jesse Hill Jr Drive Southeast, Atlanta, GA 30303, USA
| | - Adora Santos
- Emory University, Grady Memorial Hospital Glenn Building 69 Jesse Hill Jr Drive Southeast, Atlanta, GA 30303, USA
| | - Mari Freedberg
- Emory University, Grady Memorial Hospital Glenn Building 69 Jesse Hill Jr Drive Southeast, Atlanta, GA 30303, USA
| | - Phillip Kim
- Emory University, Grady Memorial Hospital Glenn Building 69 Jesse Hill Jr Drive Southeast, Atlanta, GA 30303, USA
| | - Christopher Sciarretta
- University of Tennessee, University of Tennessee College of Medicine, 975 3rd Avenue, Chattanooga, TN 37403, USA
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2
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Muggeo P, Zama D, Decembrino N, Onofrillo D, Frenos S, Colombini A, Perruccio K, Calore E, Giurici N, Ficara M, La Spina M, Mura R, De Santis R, Santoro N, Cesaro S. Ecthyma Gangrenosum in Children With Cancer: Diagnosis at a Glance: A Retrospective Study From the Infection Working Group of Italian Pediatric Hematology Oncology Association. Pediatr Infect Dis J 2022; 41:238-242. [PMID: 34694251 DOI: 10.1097/inf.0000000000003377] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND To depict ecthyma gangrenosum (EG) clinical presentation and evolution in a large multicenter pediatric retrospective collection of children with malignancies or bone marrow failure syndromes, to facilitate early diagnosis. METHODS EG episodes diagnosed in the period 2009-2019 were identified by a retrospective review of clinical charts at centers belonging to the Italian Pediatric Hematology Oncology Association. RESULTS Thirty-eight cases of EG occurring in children (male/female 16/22; median age 5.2 years) with hematologic malignancy (29), allogeneic stem cell transplantation (2) or relapsed/refractory solid tumor (3) were collected. The involved sites were: perineal region (19), limbs (10), trunk (6), head and the iliac crest (3). Bacteremia was present in 22 patients. Overall, the germs isolated were Pseudomonas aeruginosa (30), Stenotrophomonas maltophilia (3) and Escherichia coli (1); 31% of them were multidrug-resistant. All patients received antibacterial treatment, while surgery was performed in 24 patients (63.1%). Predisposing underlying conditions for EG were severe neutropenia (97.3%), corticosteroid treatment (71%) and iatrogenic diabetes (23.7%). All patients recovered, but EG recurred in 5 patients. Nine patients (24%) showed sequelae (deep scars, with muscle atrophy in 2). Four patients (10.5%) died, 1 due to relapse of EG with Carbapenem-resistant Enterobacteriaceae co-infection and 3 due to the progression of the underlying disease. CONCLUSIONS EG requires early recognition and a proper and timely treatment to obtain the recovery and to avoid larger necrotic lesions, eventually evolving in scarring sequelae.
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Affiliation(s)
- Paola Muggeo
- From the Pediatric Oncology and Hematology, University Hospital of Policlinico, Bari
| | - Daniele Zama
- Paediatric Oncology and Haematology Unit "Lalla Seràgnoli", Department of Paediatrics, University of Bologna, Sant'Orsola Malpighi Hospital, Bologna
| | - Nunzia Decembrino
- Pediatric Hematology Oncology, IRCCS Policlinico San Matteo, University of Pavia
- Terapia Intensiva Neonatale, AOU Policlinico "G. Rodolico-San Marco", Catania
| | - Daniela Onofrillo
- UOS di Oncoematologia Pediatrica, Dipartimento di Ematologia, Medicina Trasfusionale e Biotecnologie, Ospedale Spirito Santo, Pescara
| | | | - Antonella Colombini
- Pediatric Hemato-Oncology, Fondazione MBBM, Milano Bicocca University, San Gerardo Hospital, Monza
| | - Katia Perruccio
- Pediatric Hematology Oncology, Azienda Ospedaliera Universitaria, Ospedale Santa Maria della Misericordia, Perugia
| | - Elisabetta Calore
- Clinic of Pediatric Hemato-Oncology, Department of Women's and Children's Health, University Hospital of Padova
| | - Nagua Giurici
- Institute for Maternal and Child Health IRCCS Burlo Garofolo Trieste
| | - Monica Ficara
- Scuola di Specializzazione in Pediatria, Università degli Studi di Modena e Reggio Emilia; SC di Oncoematologia Pediatrica, AOU Policlinico di Modena
| | - Milena La Spina
- Centro di Riferimento Regionale di Ematologia ed Oncologia Pediatrica, AOU Policlinico "G. Rodolico-San Marco", Catania
| | - Rosamaria Mura
- Oncoematologia Pediatrica e Patologia della Coagulazione, Ospedale Pediatrico Microcitemico "Antonio Cao", AO Brotzu, Cagliari
| | - Raffaella De Santis
- UOC Oncoematoogia Pediatrica, IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo
| | - Nicola Santoro
- From the Pediatric Oncology and Hematology, University Hospital of Policlinico, Bari
| | - Simone Cesaro
- Pediatric Hematology Oncology, Azienda Ospedaliera Universitaria Integrata, Policlinico "G.B: Rossi", Verona, Italy
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3
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Gkoufa A, Sklapani P, Trakas N, Georgakopoulou VE. A Challenging Cutaneous Lesion in a Patient With Chronic Idiopathic Neutropenia. Cureus 2022; 14:e21225. [PMID: 35186525 PMCID: PMC8844289 DOI: 10.7759/cureus.21225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/13/2022] [Indexed: 12/02/2022] Open
Abstract
Ecthyma gangrenosum (EG) is an uncommon necrotizing vasculitis that affects mainly immunocompromised and burn patients, and it is frequently associated with Pseudomonas aeruginosa bacteremia. However, cases of EG with other related pathogens and cases of EG affecting immunocompetent hosts have also been described in the literature. Besides, less common cases of EG without bacteremia have been reported. Herein, we describe a rare case of EG due to Pseudomonas aeruginosa without bacteremia in a patient with chronic idiopathic neutropenia (CIN). Considering the high mortality rate associated with EG, early diagnosis and appropriate effective treatment are crucial.
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4
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Murteira F, Leal N, Silva C. Ecthyma gangrenosum: A view of blood on the skin. Clin Case Rep 2021; 9:e04259. [PMID: 34429972 PMCID: PMC8365395 DOI: 10.1002/ccr3.4259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Revised: 03/16/2021] [Accepted: 04/10/2021] [Indexed: 11/13/2022] Open
Abstract
Cutaneous findings should be actively sought in suspected cases of sepsis, as some of them (such as ecthyma gangrenosum) may provide clues about the infectious agent involved and the patient's immunosuppression status.
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Affiliation(s)
- Fábio Murteira
- Internal Medicine DepartmentCentro Hospitalar Vila Nova de Gaia/EspinhoVila Nova de GaiaPortugal
| | - Nuno Leal
- Internal Medicine DepartmentCentro Hospitalar Vila Nova de Gaia/EspinhoVila Nova de GaiaPortugal
| | - Carina Silva
- Internal Medicine DepartmentCentro Hospitalar Vila Nova de Gaia/EspinhoVila Nova de GaiaPortugal
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5
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Abstract
Gram-negative bacteremia is a devastating public health threat, with high mortality in vulnerable populations and significant costs to the global economy. Concerningly, rates of both Gram-negative bacteremia and antimicrobial resistance in the causative species are increasing. Gram-negative bacteremia develops in three phases. First, bacteria invade or colonize initial sites of infection. Second, bacteria overcome host barriers, such as immune responses, and disseminate from initial body sites to the bloodstream. Third, bacteria adapt to survive in the blood and blood-filtering organs. To develop new therapies, it is critical to define species-specific and multispecies fitness factors required for bacteremia in model systems that are relevant to human infection. A small subset of species is responsible for the majority of Gram-negative bacteremia cases, including Escherichia coli, Klebsiella pneumoniae, Pseudomonas aeruginosa, and Acinetobacter baumannii The few bacteremia fitness factors identified in these prominent Gram-negative species demonstrate shared and unique pathogenic mechanisms at each phase of bacteremia progression. Capsule production, adhesins, and metabolic flexibility are common mediators, whereas only some species utilize toxins. This review provides an overview of Gram-negative bacteremia, compares animal models for bacteremia, and discusses prevalent Gram-negative bacteremia species.
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Affiliation(s)
- Caitlyn L Holmes
- Department of Pathology, University of Michigan Medical School, Ann Arbor, Michigan, USA
- Department of Microbiology and Immunology, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Mark T Anderson
- Department of Microbiology and Immunology, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Harry L T Mobley
- Department of Microbiology and Immunology, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Michael A Bachman
- Department of Pathology, University of Michigan Medical School, Ann Arbor, Michigan, USA
- Department of Microbiology and Immunology, University of Michigan Medical School, Ann Arbor, Michigan, USA
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6
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Wiedemann GM, Schneider J, Verbeek M, Konukiewitz B, Spinner CD, Einwächter H, Schmid RM, Rothe K. An Eschar-like souvenir from a journey to Colombia: Ecthyma gangrenosum as a differential diagnosis of tropical diseases in immunocompromised patients - a case report. BMC Infect Dis 2021; 21:344. [PMID: 33845789 PMCID: PMC8042936 DOI: 10.1186/s12879-021-05998-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Accepted: 03/18/2021] [Indexed: 11/28/2022] Open
Abstract
Background Ecthyma gangrenosum (EG) is a cutaneous infectious disease characterized by eschar-like skin ulcers typically caused by Pseudomonas aeruginosa. Here, we report a case of relapsing EG in a patient who had returned from a trip to Colombia, thus establishing EG as an important differential diagnosis of tropical diseases, and demonstrating that even long-term antibiotic treatment can result in only partial remission of EG. Case presentation A 77-year-old man with underlying chronic lymphocytic leukemia (CLL) on ibrutinib treatment was admitted because of a superinfected mosquito bite on the left ear and multiple partially necrotic skin lesions disseminated all over the entire body five days after returning from a trip to Colombia. The initial clinical suspicion of a tropical disease (leishmaniosis, systemic mycosis, or others) could not be confirmed. During the diagnostic workup, microbiological cultures of the skin biopsies and bronchoalveolar lavage revealed Pseudomonas aeruginosa, leading to a diagnosis of EG. Initial antibiotic treatment resulted in partial remission. However, the patient had to be re-admitted due to a relapse 3–4 weeks after the first episode. Finally, the patient was successfully treated with a combined approach consisting of antibiotics, recurrent surgical incisions, and administration of immunoglobulins. Conclusions In conclusion, EG should be considered as a differential diagnosis in immunosuppressed patients presenting with eschar-like skin ulcers. A combined treatment approach seems to be the best choice to achieve clinical cure and avoid relapse.
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Affiliation(s)
- Gabriela M Wiedemann
- Department of Internal Medicine II, University hospital rechts der Isar, Technical University of Munich, School of Medicine, Munich, Germany.
| | - Jochen Schneider
- Department of Internal Medicine II, University hospital rechts der Isar, Technical University of Munich, School of Medicine, Munich, Germany.,German Center for Infection Research (DZIF), partner site Munich, Munich, Germany
| | - Mareike Verbeek
- Department of Internal Medicine III, University hospital rechts der Isar, Technical University of Munich, School of Medicine, Munich, Germany
| | - Björn Konukiewitz
- Institute of Pathology, Technical University of Munich, School of Medicine, Munich, Germany
| | - Christoph D Spinner
- Department of Internal Medicine II, University hospital rechts der Isar, Technical University of Munich, School of Medicine, Munich, Germany.,German Center for Infection Research (DZIF), partner site Munich, Munich, Germany
| | - Henrik Einwächter
- Department of Internal Medicine II, University hospital rechts der Isar, Technical University of Munich, School of Medicine, Munich, Germany
| | - Roland M Schmid
- Department of Internal Medicine II, University hospital rechts der Isar, Technical University of Munich, School of Medicine, Munich, Germany.,German Center for Infection Research (DZIF), partner site Munich, Munich, Germany
| | - Kathrin Rothe
- German Center for Infection Research (DZIF), partner site Munich, Munich, Germany.,Institute for Medical Microbiology, Immunology and Hygiene, Technical University of Munich, School of Medicine, Munich, Germany
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7
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Shareef N, Syed M. Disseminated fusariosis presenting as ecthyma gangrenosum. Postgrad Med J 2021; 98:e38. [PMID: 37066568 DOI: 10.1136/postgradmedj-2020-139689] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 01/16/2021] [Accepted: 01/19/2021] [Indexed: 11/04/2022]
Affiliation(s)
- Naser Shareef
- Lake Erie College of Osteopathic Medicine Bradenton Campus, Bradenton, Florida, USA
| | - Misbahuddin Syed
- Internal and Hospital Medicine, Moffitt Cancer Center, Tampa, Florida, USA
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8
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Ulpiano Trillig A, Miendje Deyi VY, Youatou P, Konopnicki D. Echtyma gangrenosum caused by coinfection with group A Streptococcus and Staphylococcus aureus: an emerging etiology? Case reports and literature review. Acta Clin Belg 2021; 76:53-57. [PMID: 31210583 DOI: 10.1080/17843286.2019.1630570] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Ecthyma gangrenosum (EG) is a potentially lethal skin infection, most commonly due to Pseudomonas aeruginosa with bacteremic dissemination and affecting mostly immunocompromised patients. We present two cases of EG in two men in Belgium recently admitted to our hospital, caused by a suspected coinfection by group A Streptococcus and Staphylococcus aureus, with a cutaneous dissemination, in which multiple impetigo lesions were the portal of entry. The first patient had no risk factors nor immunodeficiency, but the second was a homeless man with drug and alcohol abuse and advanced HIV infection. Early management of the condition is crucial, with initial broad spectrum antibiotherapy, rapidly narrowed down to the germs identified and skin lesion debridement if necessary. Any immunocompromising condition must be ruled out in any patient suffering from EG.
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Affiliation(s)
- Antonio Ulpiano Trillig
- Emergency Department, Saint-Pierre-University Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | | | - Pierre Youatou
- Emergency Department, Saint-Pierre-University Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Deborah Konopnicki
- Infectious Diseases Department, Saint-Pierre-University Hospital, Université Libre de Bruxelles, Belgium
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9
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Clinical and Histopathologic Characteristics of the Main Causes of Vascular Occusion — Part I: Thrombi. ACTAS DERMO-SIFILIOGRAFICAS 2021. [DOI: 10.1016/j.adengl.2020.12.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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10
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Beato Merino MJ, Diago A, Fernández-Flores Á, Fraga J, García Herrera A, Garrido M, Idoate Gastearena MÁ, Llamas-Velasco M, Monteagudo C, Onrubia J, Pérez-González YC, Pérez Muñoz N, Ríos-Martín JJ, Ríos-Viñuela E, Rodríguez Peralto JL, Rozas Muñoz E, Sanmartín O, Santonja C, Santos-Briz Á, Saus C, Suárez Peñaranda JM, Velasco Benito V. Clinical and Histopathologic Characteristics of the Main Causes of Vascular Occlusion - Part I: Thrombi. ACTAS DERMO-SIFILIOGRAFICAS 2020; 112:1-13. [PMID: 33045208 PMCID: PMC7546665 DOI: 10.1016/j.ad.2020.09.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2020] [Accepted: 09/26/2020] [Indexed: 11/26/2022] Open
Abstract
La patología vascular oclusiva es causante de diversas y variadas manifestaciones clínicas, algunas de las cuales son de catastróficas consecuencias para el paciente. Sin embargo, las causas de tal oclusión son muy variadas, extendiéndose desde trombos por acción descontrolada de los mecanismos de coagulación, hasta anomalías de los endotelios de los vasos u oclusión por materiales extrínsecos. En una serie de dos artículos hacemos una revisión de las principales causas de oclusión vascular, resumiendo sus manifestaciones clínicas principales y los hallazgos histopatológicos fundamentales. Esta primera parte corresponde a las oclusiones vasculares que cursan con trombos.
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Affiliation(s)
- M J Beato Merino
- Servicio de Anatomía Patológica, Hospital Universitario «La Paz», Madrid, España
| | - A Diago
- Servicio de Dermatología, Hospital Universitario Miguel Servet, Zaragoza, España
| | - Á Fernández-Flores
- Servicio de Anatomía Patológica, Hospital Universitario El Bierzo, Ponferrada, España.
| | - J Fraga
- Servicio de Anatomía Patológica, Hospital Universitario de La Princesa, Madrid, España
| | - A García Herrera
- Servicio de Anatomía Patológica, Hospital Clínic, Barcelona, España
| | - M Garrido
- Servicio de Anatomía Patológica, Hospital Universitario 12 de Octubre, Madrid, España
| | - M Á Idoate Gastearena
- Servicio de Anatomía Patológica, Hospital Universitario Virgen Macarena. Departamento de Citología, Histología y Anatomía Patológica, Facultad de Medicina, Universidad de Sevilla, España
| | - M Llamas-Velasco
- Servicio de Dermatología, Hospital Universitario de La Princesa, Madrid, España
| | - C Monteagudo
- Servicio de Anatomía Patológica, Hospital Clínico Universitario de Valencia. Facultad de Medicina, Universidad de Valencia, Valencia, España
| | - J Onrubia
- Servicio de Anatomía Patológica. Hospital Universitario San Juan de Alicante, Alicante, España
| | | | - N Pérez Muñoz
- Servicio de Anatomía Patológica. Hospital Universitari General de Catalunya. Quirónsalud, Barcelona, España
| | - J J Ríos-Martín
- Servicio de Anatomía Patológica. Hospital Universitario Virgen Macarena, Sevilla, España
| | - E Ríos-Viñuela
- Servicio de Dermatología, Fundación Instituto Valenciano de Oncología, Valencia, España
| | - J L Rodríguez Peralto
- Departamento de Anatomía Patológica, Hospital Universitario 12 de Octubre, Universidad Complutense, Instituto de Investigación I+12, Madrid, España
| | - E Rozas Muñoz
- Departamento de Dermatología, Hospital de San Pablo, Coquimbo, Chile
| | - O Sanmartín
- Servicio de Dermatología, Fundación Instituto Valenciano de Oncología, Valencia, España
| | - C Santonja
- Servicio de Anatomía Patológica, Fundación Jiménez Díaz, Madrid, España
| | - Á Santos-Briz
- Servicio de Anatomía Patológica, Hospital Universitario de Salamanca, Salamanca, España
| | - C Saus
- Servicio de Anatomía Patológica, Hospital Universitario Son Espases, Palma de Mallorca, España
| | - J M Suárez Peñaranda
- Servicio de Anatomía Patológica, Hospital Clínico Universitario de Santiago, España
| | - V Velasco Benito
- Servicio de Anatomía Patológica, Hospital Universitario de Cruces, Barakaldo, Vizcaya, España
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11
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Yohannan B, Feldman M. Orbital ecthyma gangrenosum in multiple myeloma. Proc (Bayl Univ Med Cent) 2019; 32:593-595. [DOI: 10.1080/08998280.2019.1641059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Revised: 06/28/2019] [Accepted: 07/01/2019] [Indexed: 10/26/2022] Open
Affiliation(s)
- Binoy Yohannan
- Department of Internal Medicine, Texas Health Presbyterian Hospital, Dallas, Texas
| | - Mark Feldman
- Department of Internal Medicine, Texas Health Presbyterian Hospital, Dallas, Texas
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12
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Zanella A, Faure C, Merle C, Charollais R, Aubin F. Localized ecthyma gangrenosum without sepsis in a neutropenic patient with a myelodysplastic syndrome-Refractory anemia with excess blasts type 2. Clin Case Rep 2019; 7:1754-1756. [PMID: 31534742 PMCID: PMC6745369 DOI: 10.1002/ccr3.2314] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Revised: 06/12/2019] [Accepted: 06/16/2019] [Indexed: 11/11/2022] Open
Abstract
The diagnosis of ecthyma gangrenosum should be evoked in front of maculopapular lesions rapidly evolving to necroting ulcers, particularly in the presence of prolonged neutropaenia or other hematological malignancies.
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Affiliation(s)
- Anaïs Zanella
- Service de DermatologieCHU and EA3181BesançonFrance
- Service de DermatologieCentre Hospitalier de la Haute SaôneVesoulFrance
| | - Cyril Faure
- Service d’HématologieCentre Hospitalier de la Haute SaôneVesoulFrance
| | - Catherine Merle
- Service de DermatologieCentre Hospitalier de la Haute SaôneVesoulFrance
| | - Romain Charollais
- Service de DermatologieCHU and EA3181BesançonFrance
- Service de DermatologieCentre Hospitalier de la Haute SaôneVesoulFrance
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13
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Marcellino CR, Perry A, Graffeo CS. Ecthyma Gangrenosum Secondary to Pseudomonal Sepsis Complicated by Acute Respiratory Distress Syndrome Following Craniotomy for Resection of a Metastasis. Cureus 2019; 11:e5543. [PMID: 31687315 PMCID: PMC6819064 DOI: 10.7759/cureus.5543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Ecthyma gangrenosum is a rare physical exam finding pathognomonic for severe bacteremia and typically associated with pseudomonal sepsis. The characteristic skin lesions appear as ring-shaped hemorrhagic pustules that evolve into necrotic ulcers. In the present case, a 62-year-old woman with a pulmonary adenocarcinoma treated with surgical resection and adjuvant chemotherapy developed three symptomatic brain masses. The lesions were presumed metastatic and initially treated with stereotactic radiosurgery; however, follow-up imaging identified treatment failure of a cerebellar lesion, and the patient was subsequently taken to surgery on an elective basis for suboccipital craniotomy and tumor resection. Although her initial postoperative course was unremarkable, on postoperative day two, she experienced a rapidly progressive neurologic and hemodynamic decline. During this period, numerous ring-shaped, necrotic cutaneous lesions rapidly appeared, consistent with ecthyma gangrenosum. In spite of multi-modality critical care treatment and resuscitation, including milrinone, multiple vasopressors, anti-pseudomonal antibiotics, and prone positioning, the patient progressed to cardiorespiratory failure and died.
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Affiliation(s)
| | - Avital Perry
- Neurological Surgery, Mayo Clinic, Rochester, USA
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14
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Fukui KO, Shoji K, Nagai Y, Shindo T, Hikosaka M, Kuwahara K, Ishiguro A, Miyairi I. Ecthyma gangrenosum in a 3-year-old boy post-heart transplantation. Transpl Infect Dis 2019; 21:e13131. [PMID: 31216602 DOI: 10.1111/tid.13131] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Revised: 05/25/2019] [Accepted: 06/09/2019] [Indexed: 11/27/2022]
Abstract
Ecthyma gangrenosum (EG) is a serious bacterial infection in immunocompromised patients. EG in transplant recipients is rarely reported and may go unrecognized, which may delay initiation of appropriate treatment. We report a case of EG in a pediatric heart transplant recipient who was treated successfully with antibiotics and surgical debridement.
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Affiliation(s)
- Kana Okazaki Fukui
- Center of Postgraduate Education and Training, National Center for Child Health and Development, Setagaya-ku, Japan
| | - Kensuke Shoji
- Division of Infectious Diseases, Department Medical Subspecialties, National Center for Child Health and Development, Setagaya-ku, Japan
| | - Yusa Nagai
- Center of Postgraduate Education and Training, National Center for Child Health and Development, Setagaya-ku, Japan
| | - Takahiro Shindo
- Division of Cardiology, Department Medical Subspecialties, National Center for Child Health and Development, Setagaya-ku, Japan
| | - Makoto Hikosaka
- Division of Plastic Surgery, Department of Surgical Subspecialties, National Center for Child Health and Development, Setagaya-ku, Japan
| | - Kosuke Kuwahara
- Division of Plastic Surgery, Department of Surgical Subspecialties, National Center for Child Health and Development, Setagaya-ku, Japan
| | - Akira Ishiguro
- Center of Postgraduate Education and Training, National Center for Child Health and Development, Setagaya-ku, Japan
| | - Isao Miyairi
- Division of Infectious Diseases, Department Medical Subspecialties, National Center for Child Health and Development, Setagaya-ku, Japan.,Department of Microbiology, Immunology, and Biochemistry, University of Tennessee Health Science Center, Memphis, Tennessee, USA
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