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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 Apr 3:e12887. Epub 2019 Apr 3.

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 Dec 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 2018 Dec 7. 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 May 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

J Cutan Med Surg 2017 Sep/Oct;21(5):425-437. Epub 2017 May 4.

4 University of Missouri Kansas City, Department of Internal Medicine, Kansas City, MO, USA.

Acute cutaneous necrosis is characterised by a wide range of aetiologies and is associated with significant morbidity and mortality, warranting complex considerations in management. Early recognition is imperative in diagnosis and management of sudden gangrenous changes in the skin. This review discusses major causes of cutaneous necrosis, examines the need for early assessment, and integrates techniques related to diagnosis and management. Read More

Rev Chil Pediatr 2017 02;88(1):136-141

Unidad de Paciente Crítico Pediátrico, Clínica Santa María, Santiago, Chile.

Primary immunodeficiency diseases (PID) are congenital disorders secondary to an impaired immune response. Infections, autoimmune disorders, atopy, and lymphoproliferative syndromes are commonly associated with this disorder.

Objective: To present and discuss 3 infants diagnosed with PID. Read More

Medicine (Baltimore) 2017 Mar;96(10):e6244

aDepartment of Dermatology bDepartment of Urology, The Second Affiliated Hospital & Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang cDepartment of Dermatology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, People's Republic of China.

Rationale: Ecthyma gangrenosum (EG) is an aggressive cutaneous disease caused by local or systemic infection with Pseudomonas aeruginosa. EG is characterized by cutaneous manifestations ranging from nodule and papule, to necrotic ulceration with surrounding erythema, especially with black eschar or central crust. EG presents with characteristic skin lesions which is important to establish diagnosis of sepsis caused by P aeruginosa, a serious condition that can be treated efficiently if diagnosed early. Read More

Clin Exp Dermatol 2017 Apr 27;42(3):324-327. Epub 2017 Feb 27.

Department of Dermatology, St George's Hospital, London, UK.

Ecthyma gangrenosum (EG) is often defined as a cutaneous manifestation of Pseudomonas aeruginosa septicaemia, typically secondary to neutropenia. There is increasing recognition that a broader definition is warranted, as numerous causative organisms and predisposing conditions have been reported. We describe two cases of EG that occurred without bacteraemia. Read More

Actas Dermosifiliogr 2017 05 1;108(4):369-371. Epub 2017 Feb 1.

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

An Bras Dermatol 2016 Nov-Dec;91(6):815-816

University of Bari - Bari, Italy.

Ecthyma gangrenosum is an uncommon dermatological manifestation characterized by round, indurated ulcers with a central necrotic black eschar and surrounding erythema. This report describes the case of a 5-year-old girl, affected by acute lymphocytic leukemia, presenting with a black eschar on her right thigh. Such lesions should always be correctly identified to avoid potentially fatal bacteraemia. Read More

Medicine (Baltimore) 2017 Jan;96(2):e5507

Pediatric Hospitals of Nice CHU-Lenval, Nice, France.

Rationale: Ecthyma gangrenosum (Eg) is a necrotic lesion that is mostly seen in immunocompromised patients. It reflects a severe sepsis, possibly caused by Pseudomonas aeruginosa (Pa).

Patient Concerns: A healthy 3-year-old girl admitted to the Pediatric Emergency Department presented a sepsis-associated purpura with neurological and respiratory distress. Read More

BMJ Case Rep 2017 Jan 4;2017. Epub 2017 Jan 4.

Department of Internal Medicine (Clinical Hematology Division), Post Graduate Institute of Medical Education and Research, Chandigarh, India.

Am J Dermatopathol 2017 Sep;39(9):637-662

*Associate Staff of the Department of Dermatology, Department of Dermatology, Hospital Universitario de la Princesa, Universidad Autónoma, Madrid, Spain; †Associate Staff of the Department of Dermatology, Department of Dermatology, Fundación Jiménez Diaz, Universidad Autónoma, Madrid, Spain; ‡Director of Dermatopathology, Department of Dermatology, Hospital Clínico Universitario, Salamanca, Spain; §Director of Dermatopathology, Dermatopathology Research Unit, Medical University of Graz, Graz, Austria; ¶Director of Dermatopathology, Dermatopathologie Laboratory, Friedrichschafen, Germany; and ‖Chairman of the Department of Dermatology, Department of Dermatology, Hospital Clínico Universitario, Salamanca, Spain.

We review the most characteristic clinical and histopathologic findings of the cutaneous manifestations of the occlusive nonvasculitic vasculopathic disorders. Clinically, most of these conditions are characterized by retiform purpura. Histopathologic findings consist of occlusion of the vessel lumina with no vasculitis. Read More

Pediatr Int 2016 Sep;58(9):950-2

Department of Pediatric Gastroenterology, Kent Hospital, İzmir, Turkey.

Ecthyma gangrenosum is a rare, necrotizing, bacterial infection of the skin most commonly caused by Pseudomonas aeruginosa. It has a characteristic clinical picture starting with maculopapular eruption followed by hemorrhagic vesicle and evolving into gangrenous ulcer. Although direct skin inoculation without septicemia is also probable, usually ecthyma gangrenosum is pathognomonic for Pseudomonas septicemia, which has a mortality rate of 38-96%. Read More

Rev Chilena Infectol 2016 Jun;33(3):336-9

Departamento de Medicina Interna, Pontificia Universidad Católica de Chile, Chile.

Ecthyma gangrenosum is an uncommon necrotizing vasculitis, in most cases secondary to sepsis by Pseudo-mona aeruginosa in immunocompromised patients. However, there have been several reports of ecthyma gangre-nosum caused by other infectious etiologies. We report an unusual case of ecthyma gangrenosum associated with methicillin-resistant Staphylococcus aureus infection in a patient without the classic immunological risk factors described in the literature. Read More

Nefrologia 2016 Sep - Oct;36(5):573-574. Epub 2016 Aug 1.

Servicio de Nefrología, Hospital Universitario de La Princesa, Madrid, España. Electronic address:

Ann Dermatol Venereol 2016 Oct 28;143(10):607-610. Epub 2016 Jul 28.

Service de dermatologie vénéréologie, CHU Yalgado-Ouédraogo, BP 7021, Ouagadougou 03, Burkina Faso; Université Ouaga I, Ouagadougou, Burkina Faso.

Background: Ecthyma gangrenosum is an acute ulcer necrotic skin infection frequently caused by Pseudomonas aeruginosa. It is characterised by necrotic ulcerations circumscribed by an inflammatory halo. Lesions are normally found in the anal, genital and axillary regions. Read More

Medicine (Baltimore) 2016 Jul;95(29):e4212

aDepartment of Dermatology bDepartment of Vascular Surgery cDepartment of Pathology dDepartment of Infectious Diseases, Hospital del Mar, Parc de Salut Mar, Universitat Autònoma de Barcelona, Barcelona, Spain.

Background: Diffuse dermal angiomatosis (DDA) is a rare, acquired, reactive vascular proliferation, clinically characterized by livedoid erythematous-violaceous plaques, which frequently evolve to ulceration and necrosis. Histopathologically, it is manifested by a diffuse proliferation of endothelial cells within the full thickness of the dermis. DDA has been mainly associated with severe peripheral atherosclerosis. Read More

Mycopathologia 2016 Oct 21;181(9-10):759-63. Epub 2016 Jun 21.

CBS-KNAW Fungal Biodiversity Centre, PO Box 85167, 3508 AD, Utrecht, The Netherlands.

Ecthyma gangrenosum (EG) involves necrotic cutaneous lesions caused by bacteria, mainly Pseudomonas aeruginosa, and is usually seen in immunocompromised patients with septicemia. However, clinically similar infections have been published with fungi as etiologic agents. We present a case of an EG-like lesion due to Fusarium oxysporum confirmed by clinical diagnosis, culture and molecular identification and discuss the definition of EG. Read More

Case Rep Med 2016 6;2016:8502150. Epub 2016 Apr 6.

Department of Pediatrics, Division of Neonatology, Yuzuncu Yil University School of Medicine, 65080 Van, Turkey.

Ecthyma gangrenosum is a cutaneous lesion often associated with pseudomonas aeruginosa bacteremia, even though it may develop without bacteremia and may originate from other bacterial and fungal organisms. Pseudomonas aeruginosa bacteremia or sepsis, which mainly affects immunocompromised patients, frequently occurs in hospitals. This lesion typically occurs on the extremities and gluteal and perineal regions. Read More

Turk Pediatri Ars 2016 Mar 1;51(1):46-8. Epub 2016 Mar 1.

Department of Dermatology and Veneral Diseases, Dicle University School of Medicine, Diyarbakır, Turkey.

Ecthyma gangrenosum is a skin lesion associated with Pseudomonas aeruginosa. A previously healthy one-year-old boy who had been diagnosed with varicella 10 days ago was admitted to our hospital with complaints of diarrhea, green ear discharge and new lesions in the diaper area. Intravenous meropenem and amikacin had been previously initiated. Read More

BMJ Case Rep 2016 Mar 30;2016. Epub 2016 Mar 30.

Department of Thoracic Surgery, Hopital de Jolimont, Haine Saint Paul, Belgium.

A 68-year-old woman with a history of breast cancer presented with skin lesions and sternal pain. Clinical examination revealed ulcerative lesions on mastectomy scar and CT scan showed contiguous sternal osteolysis. The main hypothesis was a breast cancer recurrence; however, cutaneous and bone biopsies did not reveal any cancer cells. Read More

Dermatol Online J 2016 Jan 15;22(1). Epub 2016 Jan 15.

University of Texas Southwestern Medical Center.

Disseminated candidiasis in immunosuppressed patients has been classically associated with an erythematous papular eruption, however more severe presentations are possible. We present a patient who developed disseminated Candida tropicalis that presented with hemorrhagic bullae that progressed to large necrotic ulcers. Read More