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An Bras Dermatol 2020 Jul - Aug;95(4):407-417. Epub 2020 May 16.

Faculdade de Medicina, Universidade Estadual Paulista, Botucatu, SP, Brazil. Electronic address:

The severe bacterial diseases discussed herein are those that present dermatological lesions as their initial manifestations, for which the dermatologist is often called upon to give an opinion or is even the first to examine the patient. This review focuses on those that evolve with skin necrosis during their natural history, that is, necrotizing fasciitis, Fournier gangrene, and ecthyma gangrenosum. Notice that the more descriptive terminology was adopted; each disease was individualized, rather than being referred by the generic term "necrotizing soft tissue infections". Read More

Int J Infect Dis 2020 Jun 1;97:19-20. Epub 2020 Jun 1.

Service de médecine intensive et reanimation, hôpital Saint-Louis, 1 Avenue Claude Vellefaux, 75010, Paris, France.

Transpl Infect Dis 2020 May 12:e13319. Epub 2020 May 12.

Division of Infectious Diseases, Department of Internal Medicine, Wake Forest Baptist Health, Winston-Salem, NC, USA.

Ecthyma gangrenosum is a cutaneous manifestation of severe systemic pseudomonas infection and is commonly associated with bacteremia. It is common in immunocompromised patients with underlying neutropenia or leukopenia. We report a patient with heart transplant who developed a single lesion of ecthyma gangrenosum in the absence of bacteremia with a review of reported cases in solid organ transplant patients. Read More

Orbit 2020 Apr 30. Epub 2020 Apr 30.

Department of Dermatology, Austin Regional Clinic, Austin, TX, USA.

J Microbiol Immunol Infect 2020 Apr 17. Epub 2020 Apr 17.

Department of Pediatrics, Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan; Department of Pediatrics, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan. Electronic address:

X-linked agammaglobulinemia (XLA) is a primary immunodeficiency disease. We reported two 7-month-old identical male twins with Pseudomonas aeruginosa sepsis who initially manifested as oral ecthyma gangrenosum and were finally diagnosed to have XLA. In both cases, we confirmed the c. Read More

J Clin Rheumatol 2020 Feb 19. Epub 2020 Feb 19.

From the University of Florida Health, Jacksonville, FL.

Curr Opin Infect Dis 2020 Apr;33(2):101-109

Division of Infectious Diseases, Department of Health Sciences DISSAL, University of Genoa.

Purpose Of Review: Skin and soft tissue infections (SSTIs) in patients with hematological malignancies are frequent, but dedicated epidemiological studies are limited. The aim of this review is to provide updated description of the main etiological agents, differential diagnosis, and treatment.

Recent Findings: In addition to common causes of bacterial skin infections in any kind of patients, such as streptococci and staphylococci (the letter frequently resistant to methicillin), Pseudomonas aeruginosa is a frequent agent in patients with hematological malignancies, with high virulence and typical infection presenting as ecthyma gangrenosum. Read More

Clin Dermatol 2019 Sep - Oct;37(5):528-547. Epub 2019 Jul 17.

The Ronald O. Perelman Department of Dermatology, New York University School of Medicine, New York, New York, USA. Electronic address:

The color purple can be seen in several types of eruptions including inflammatory dermatoses like lichen planus, infectious dermatoses like ecthyma gangrenosum, neoplasms like Kaposi sarcoma, and vasculitis and vasculopathy. The current review focuses on the clinical appearance, pathophysiology, and treatment of several vasculitides and vasculopathies including capillaritis, cutaneous small-vessel vasculitis, immunoglobulin A (IgA) vasculitis, cryoglobulinemia, granulomatosis with polyangiitis, eosinophilic granulomatosis with polyangiitis, microscopic polyangiitis, polyarteritis nodosum, warfarin-induced skin necrosis, heparin-induced thrombocytopenia, purpura fulminans, antiphospholipid antibody syndrome, calciphylaxis, levamisole-induced vasculopathy, and thrombotic thrombocytopenic purpura. Dermatologists play a central role in treating patients with cutaneous vasculitis and vasculopathy and may have the opportunity to facilitate identification of systemic disease by diagnosing cutaneous vasculitis and vasculopathy. Read More

Cureus 2019 Aug 31;11(8):e5543. Epub 2019 Aug 31.

Neurological Surgery, Mayo Clinic, Rochester, USA.

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. Read More

Proc (Bayl Univ Med Cent) 2019 Oct 2;32(4):593-595. Epub 2019 Aug 2.

Department of Internal Medicine, Texas Health Presbyterian HospitalDallasTexas.

Ecthyma gangrenosum is a rare and highly lethal cutaneous infection classically associated with bacteremia. We report a 58-year-old man with multiple myeloma receiving chemotherapy who presented with 2 days of painless left periorbital swelling that rapidly progressed to a blackish eschar. His absolute neutrophil count was 0. Read More

Clin Case Rep 2019 Sep 9;7(9):1754-1756. Epub 2019 Aug 9.

Service de Dermatologie CHU and EA3181 Besançon France.

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. Read More

Am J Case Rep 2019 Sep 16;20:1369-1372. Epub 2019 Sep 16.

Office of Human Research, Memorial Healthcare System, Hollywood, FL, USA.

BACKGROUND Ecthyma gangrenosum is an uncommon cutaneous infection commonly caused by Pseudomonas aeruginosa affecting typically immunocompromised patients. The presence of ecthyma gangrenosum can be associated with severe systemic infection often with a fatal prognosis. Most cases of ecthyma gangrenosum occur around the axilla, buttocks, and limbs; the scrotum is rarely affected. Read More

Front Immunol 2019 20;10:1953. Epub 2019 Aug 20.

Department of Pediatrics, Taichung Veterans General Hospital, Taichung, Taiwan.

X-linked agammaglobulinemia (XLA), caused by a mutation in the Bruton's tyrosine kinase () gene, is rarely reported in patients with recurrent hemophagocytic lymphohistiocytosis (HLH). This mutation leads to significantly reduced numbers of circulatory B cells and serum immunoglobulins in patients. Therefore, they exhibit repetitive bacterial infections since infancy, and immunoglobulin (Ig) replacement therapy is the primary treatment. Read More

Int Wound J 2019 Dec 2;16(6):1575-1576. Epub 2019 Sep 2.

UOC Pediatria, Sant'Andrea Hospital, Rome, Italy.

IDCases 2019 11;18:e00594. Epub 2019 Jul 11.

Department of Pathology, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand.

Calciphylaxis is a rare cutaneous disease that may cause fatal complications in patients on long-term dialysis. Early diagnosis and proper management decrease complications. However, it can mimic cutaneous infections, especially ecthyma gangrenosum and cutaneous vasculitis. Read More

Transpl Infect Dis 2019 Aug 30;21(4):e13131. Epub 2019 Jun 30.

Division of Infectious Diseases, Department Medical Subspecialties, National Center for Child Health and Development, Setagaya-ku, Japan.

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. Read More

Acta Clin Belg 2019 Jun 18:1-5. Epub 2019 Jun 18.

c Infectious Diseases Department , Saint-Pierre-University Hospital, Université Libre de Bruxelles , Belgium.

Ecthyma gangrenosum (EG) is a potentially lethal skin infection, most commonly due to 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 and , 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. Read More

Medicine (Baltimore) 2019 May;98(20):e15651

Lucian Blaga University of Sibiu, Faculty of Medicine Sibiu.

Rationale: Ecthyma gangrenosum is a cutaneous infection, most commonly occurring during sepsis evolution with Pseudomonas aeruginosa on an immunocompromised background. There have been rare case reports in previously healthy children and rarer are the cases with double etiology.

Patient Concerns: We present the case of a female Caucasian patient, aged 1 year and 8 months, who developed severe sepsis during flu evolution with predominant respiratory and cerebral manifestations. Read More

Curr Med Mycol 2019 Mar;5(1):27-31

Department of Microbiology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

Background And Purpose: species is an opportunistic mold that causes disseminated infections in immunocompromised patients. Given the high mortality rate of this infection, it is important to make a definite diagnosis when encountering suspected cases.

Case Report: Herein, we presented a 35-year-old man diagnosed with acute myeloid leukemia with a prolonged febrile neutropenic period and ecthyma gangrenosum-like lesions, along with fungemia and disseminated fusariosis. Read More

Proc (Bayl Univ Med Cent) 2018 Oct 20;31(4):528-529. Epub 2018 Sep 20.

Department of Internal Medicine, Scott & White Memorial HospitalTempleTexas.

Ecthyma gangrenosum is an exceedingly rare dermatologic complication of bacteremia or fungemia in immunocompromised patients. The lesions may be single or multiple and may occur anywhere on the body. We present a case of ecthyma gangrenosum with atypical organisms and risk factors resulting in delayed diagnosis of both the condition and the underlying infectious process that caused it. Read More

Dermatol Ther 2019 05 16;32(3):e12887. Epub 2019 Apr 16.

Department of Dermatology, Venereology & Leprology, All India Institute of Medical Sciences, Jodhpur, India.

Platelet rich fibrin (PRF) gel is a new second generation platelet concentrate, which has been widely used in various dermatological conditions such as nonhealing diabetic foot ulcers, venous ulcers, and trophic ulcers in leprosy. In this case report, we present a patient with nonhealing ulcer secondary to ecthyma gangrenosum, who showed dramatic response with PRF gel. This case suggests a role of PRF gel in nonhealing ulcers of infectious etiology which has not been described in English language literature. Read More

J Glob Infect Dis 2019 Jan-Mar;11(1):43-46

Department of Internal Medicine, University of Calabar, Calabar, Cross River State, Nigeria.

Ecthyma gangrenosum (EG) is a rare, infective skin disease, predominantly but not exclusively caused by . It is often seen in individuals with immunosuppression, although it has also been reported among previously healthy individuals. It was initially thought to be pathognomonic of septicemia, but this assertion was discarded following several reports on EG without bacteremia and EG with varied bacterial and fungal etiologies. Read More

BMC Infect Dis 2019 Jan 25;19(1):85. Epub 2019 Jan 25.

Department of Internal Medicine, St Antonius Hospital, Nieuwegein/ Utrecht, Koekoekslaan 1, 3435, CM, Nieuwegein, The Netherlands.

Background: Ecthyma gangrenosum is a cutaneous infectious usually associated with P. aeruginosa. It usually develops In patients with an underlying immunodeficiency. Read More

J Eur Acad Dermatol Venereol 2019 Apr 5;33(4):781-785. Epub 2019 Mar 5.

Department of Dermatology, University Hospital Antwerp (UZA), University of Antwerp (UA), Antwerp, Belgium.

Background: Ecthyma gangrenosum (EG) is characterized by the occurrence of erythematous, violaceous or haemorrhagic macules and/or vesicles, often evolving into necrotic ulcers, with a central grey-black eschar. It is a rare skin condition, usually occurring in immunocompromised patients suffering from bacterial sepsis caused by Pseudomonas aeruginosa. However, seemingly healthy children have been diagnosed with this skin disease as well. Read More

Afr J Lab Med 2018 5;7(1):756. Epub 2018 Dec 5.

Department of Paediatrics, Usmanu Danfodiyo University Teaching Hospital, Sokoto, Nigeria.

Introduction: Ecthyma gangrenosum (EG) is a cutaneous lesion commonly caused by that involves mainly the lower limbs and gluteal region, seen more in immunosuppressed patients with neutropenia. Cancrum oris (Noma) is a gangrenous necrosis of the face that begins as a gingival ulcer and progresses rapidly to destroy contiguous tissues in malnourished children.

Case Presentation: This article reports a case of facial EG which was similar to Noma in a malnourished child: a 16-month old girl with fever, cough, weight loss, watery stool and swelling on right cheek. Read More

Cold Spring Harb Mol Case Stud 2018 12 17;4(6). Epub 2018 Dec 17.

Division of Infectious Disease, Department of Pediatrics, UCSD, San Diego, California 92093, USA.

X-linked agammaglobulinemia (XLA, OMIM#300300) is a rare monogenic primary immunodeficiency caused by mutations in the Bruton tyrosine kinase () gene. XLA is characterized by insufficient immunoglobulin levels and susceptibility to life-threatening bacterial infections. We report on a patient that presented with ecthyma gangrenosum and septicemia. Read More

Int J Dermatol 2019 Apr 12;58(4):E83-E85. Epub 2018 Dec 12.

Dermatology Department, University Hospital of Heraklion, Crete, Greece.

Plast Reconstr Surg Glob Open 2018 Oct 3;6(10):e1953. Epub 2018 Oct 3.

Department of Pediatric Surgery, Meyer Children Hospital, Florence, Italy.

Ecthyma Gangrenosum is a manifestation of infection, usually occurring in immunocompromised patients, which can be associated with bacteremia with potentially lethal outcome. The clinical appearance is of an inflammatory cutaneous lesion with a central necrotic spot; the lesion then rapidly progresses to a gangrenous ulcer with a gray-black eschar extending in the deep soft tissues. Treatment of Ecthyma Gangrenosum includes both aggressive systemic antibiotic therapy and surgical procedures. Read More

Med Mal Infect 2019 Jun 7;49(4):288-289. Epub 2018 Dec 7.

Service de médecine intensive et de réanimation polyvalente, CHU de Reims, 51092 Reims, France.

Pan Afr Med J 2018 5;30:95. Epub 2018 Jun 5.

University Mohammed V, Ibn Sina, Hospital University, Rabat, Morocco.

Ecthyma gangrenosum (EG) is a severe potentially lethal cutaneous infection that progresses sequentially from maculopapular rash to haemorrhagic bulla and then to necrotic ulceration with surrounding erythema. It usually occurs in immunocompromised patients (aplasia secondary to chemotherapy, HIV infection, neutropenia or functional deficit of neutrophils, agammaglobulinemia). It rarely affects healthy people. Read More

Acta Haematol 2018 9;140(3):166-168. Epub 2018 Oct 9.

Department of Dermatology, Hospital Universitario de La Princesa, Madrid, Spain.

Cutis 2018 Jul;102(1):E13-E15

Division of Dermatology, David Geffen School of Medicine at University of California, Los Angeles, USA.

J Pediatr Adolesc Gynecol 2018 Dec 6;31(6):625-628. Epub 2018 Jun 6.

Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada; Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada; Department of Obstetrics and Gynecology, University of Ottawa, Ottawa, Ontario, Canada; Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; Division of Gynecology, Department of Surgery, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada. Electronic address:

Background: An 18-month-old female toddler presented with severe vulvar ulcers and pancytopenia with investigations revealing Pseudomonas aeruginosa bacteremia.

Case: A previously healthy 18-month-old female toddler presented with 6 days of fevers, vulvar rash, and ulcers. Vulvar cultures showed Staphylococcus aureus and P aeruginosa. Read More

Cureus 2018 Apr 6;10(4):e2441. Epub 2018 Apr 6.

Department of Internal Medicine, Civil Hospital Karachi, Dow University of Health Sciences (DUHS), Karachi, PAK.

Ecthyma gangrenosum is a skin lesion consequent to bacteremia, mostly due to Pseudomonas aeruginosa, although it may develop secondary to other organisms as well. The disease is often witnessed in patients with leukemia; however, a few cases of ecthyma gangrenosum in adults were reported to be associated with myelofibrosis. We report a case of ecthyma gangrenosum due to Escherichia coli (E. Read More

Am J Med 2018 05 31;131(5):510-511. Epub 2018 Jan 31.

Chief of Infectious Diseases, Veterans Affairs Medical Center, Northport, NY; Stony Brook University School of Medicine, NY. Electronic address:

J Dermatol Case Rep 2017 Dec 1;11(2):32-34. Epub 2017 Dec 1.

Micology Department, General Hospital "Dr. Manuel Gea González", Mexico City, Mexico.

Mucormycosis of the scalp is a rare cutaneous presentation of the disease. It is also an unusual infection in children. We present the case of a 4-year-old girl with acute lymphoblastic leukemia, who presented with atypical cutaneous mucormycosis simulating an lesion. Read More

Hautarzt 2018 Jun;69(6):484-486

Klinik für Dermatologie, Venerologie und Allergologie, Universitätsklinikum Leipzig, Philipp-Rosenthal-Str. 23, 04103, Leipzig, Deutschland.

This article presents the case of a patient with newly developed skin erosions and ulcerations following an exanthematous drug eruption due to sultamicillin therapy. The skin lesions were treated topically with clobetasol and prednicarbate and orally with methylprednisolone. A skin smear revealed massive growth of Escherichia coli bacteria. Read More

N Engl J Med 2017 Dec;377(23):e32

Sint Antonius Ziekenhuis, Nieuwegein, the Netherlands

An Bras Dermatol 2017 Sep-Oct;92(5):698-700

Department of Dermatology, University Hospital "Dr. José Eleuterio González", Universidad Autónoma de Nuevo León - Monterrey, México.

Ecthyma gangrenosum is a rare skin infection classically associated with Pseudomonas aeruginosa. We performed a retrospective study of all cases diagnosed with ecthyma gangrenosum from 2004-2010 in a university hospital in Mexico (8 cases, 5 female patients and 3 male patients, ages between 4 months and 2 years). The most common risk factor for ecthyma gangrenosum is neutropenia in immunocompromised patients. Read More

J Craniofac Surg 2018 03;29(2):531-532

Department of Oral and Maxillofacial Surgery, Virgen del Rocio University Hospital, Seville, Spain Department of Pathology, Virgen del Rocio University Hospital, Seville, Spain Department of Oral and Maxillofacial Surgery, Virgen del Rocio University Hospital, Seville, Spain.

Clin Exp Dermatol 2018 Jan 23;43(1):67-69. Epub 2017 Oct 23.

Dermatology Department, Kingston Hospital NHS Foundation Trust, Galsworthy Road, Kingston upon Thames, London, UK.

BMJ Case Rep 2017 Aug 29;2017. Epub 2017 Aug 29.

Department of Pediatrics, All India Institute of Medical Sciences Jodphur, Jodhpur, Rajasthan, India.

We report a previously healthy 16-month-old child who presented to us with membranous pharyngitis and ecthyma gangrenosum. In this patient, was isolated from throat swab, cerebrospinal fluid, skin swab, urine, blood and synovial fluid in a single admission. In further workup, this child was diagnosed as a case of X-linked agammaglobulinaemia. Read More

G Ital Dermatol Venereol 2017 Dec 28;152(6):615-637. Epub 2017 Jul 28.

Department of Dermatology, de La Princesa University Hospital, Madrid, Spain.

Most emergencies in dermatology comprise a variety of entities with a usually benign course. However, vasculopathies and vasculitis are not common, but they could represent respectively 1.9% and 4. Read More

Ann Dermatol Venereol 2017 Nov 2;144(11):666-675. Epub 2017 Aug 2.

Service de dermatologie, hôpital d'instruction des armées Sainte-Anne, 83800 Toulon, France. Electronic address:

Pseudomonas aeruginosa, a ubiquitous Gram-negative bacillus characterized by its greenish color and sweetish smell, is at the origin of potentially severe forms of dermatosis, such as ecthyma gangrenosum which marks immunosuppression or reveals blood-poisoning, especially in children. It frequently colonizes chronic wounds and serious burns, and spongiotic or acantholytic dermatosis, especially when severe or localized in skinfolds. It requires special care because of its high resistance to antibiotics and antiseptics. Read More

BMJ Case Rep 2017 Aug 3;2017. Epub 2017 Aug 3.

General Surgery, Sree Balaji Medical College and Hospital, Chennai, Tamil Nadu, India.

We report for the first time a case of non-pseudomonal ecthyma gangrenosum (EG) caused by methicillin-resistant in a chronic alcoholic without an associated immunocompromised state or disease. EG is an infection of the skin, commonly associated with bacteraemia, though other organisms are also known to be causally related. It usually occurs in patients who are terminally ill and the immunocompromised. Read More

BMJ Case Rep 2017 Jul 27;2017. Epub 2017 Jul 27.

Department of Pulmonary and Critical Care, Brooke Army Medical Center, Fort Sam Houston, Texas, USA.

A 55-year-old man undergoing chemotherapy for recurrent multiple myeloma presented with a 2-day history of bilateral lower leg rash with pain and oedema. On examination, there were numerous non-palpable retiform pruritic patches over both lower legs. Skin pnch biopsy demonstrated a diffuse interstitial neutrophilic infiltrate with necrosis. Read More

Med Clin (Barc) 2017 10 21;149(8):363. Epub 2017 Jul 21.

Servicio de Dermatología, Complejo Hospitalario Universitario de Pontevedra, EOXI Pontevedra-Salnés, Pontevedra, España.

Front Microbiol 2017 30;8:953. Epub 2017 May 30.

Division of Infectious Diseases, Department of Medical Specialties, Geneva University HospitalsGeneva, Switzerland.

Ecthyma gangrenosum (EG) are necrotic lesions that develop in the context of bacteremia. Isolated reports describe EG in the setting of non-Pseudomonal infections. In a patient with EG, initial blood cultures showed , and almost occulted bacteremia. Read More

Int J Womens Dermatol 2016 Sep 22;2(3):89-92. Epub 2016 Jul 22.

Departments of Medicine (Division of Infectious Diseases) and Dermatology, University of CT Health Center, Farmington, Connecticut.

Ecthyma gangrenosum (EG) is a well-described skin manifestation of septicemia in immunocompromised patients. However, it can be seen in association with other bacteria, viruses, and fungi. We report a case of a 54-year-old African American female with metastatic gastric adenocarcinoma and recent chemotherapy and neutropenia who developed EG-like lesions due to methicillin-susceptible . Read More