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J Pediatr Adolesc Gynecol 2018 Jun 6. Epub 2018 Jun 6.

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

Background: An 18-month-old female presenting with severe vulvar ulcers and pancytopenia with investigations revealing P.aeruginosa bacteremia.

Case: Previously healthy 18-month-old female presented with 6 days of fevers, vulvar rash and ulcers. 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 Oct 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

J Assoc Physicians India 2016 Jan;64(1):55

Armed Forces Medical College, Pune.

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

Indian Dermatol Online J 2016 Jan-Feb;7(1):36-9

Department of Tropical Medicine, School of Tropical Medicine, Kolkata, West Bengal, India.

Ecthyma gangrenosum (EG) is a cutaneous lesion classically associated with potentially fatal Pseudomonas septicemia in immunocompromised patients. Other bacterial and fungal pathogens have also been implicated. Although EG typically occurs in immunocompromised or neutropenic patients, it may occasionally affect a previously healthy person. Read More

Front Med 2016 Mar 3;10(1):101-3. Epub 2016 Mar 3.

Department of Urology, Rush University Medical Center, Chicago, IL, 60612, USA.

A 43-year-old man with pancytopenia from chemotherapy for acute myeloid leukemia developed left scrotal pain, fever, and rigors. Physical exam revealed an ulcerating lesion with central necrosis and eschar surrounded by a halo of erythema on the inferior aspect of the left scrotum. The condition indicated an early necrotizing soft tissue infection. Read More

Indian J Cancer 2015 Jan-Mar;52(1):79-80

Department of Dermatology, SDM College of Medical Sciences and Hospital, Sattur, Dharwad, Karnataka, India.

Pediatr Emerg Care 2016 Jan;32(1):46-8

From the Division of General Pediatrics, The Children's Hospital of Philadelphia, and Department of Pediatrics, Grand View Hospital, Sellersville, PA.

We present the case of a 1-year-old healthy boy who was taking oral antibiotics for an otitis media and then developed an erythematous penile lesion that rapidly became ulcerated. He was admitted to the hospital for further diagnostic studies and intravenous therapy, and his wound culture grew Pseudomonas aeruginosa, consistent with the diagnosis of ecthyma gangrenosum. Serial blood counts also demonstrated a progressive neutropenia, and an immunodeficiency evaluation resulted in the diagnosis of autoimmune neutropenia of childhood. Read More

J Dermatol 2016 Apr 24;43(4):460-2. Epub 2015 Dec 24.

Department of Dermatology, The Jikei University School of Medicine, Tokyo, Japan.

Acta Dermatovenerol Alp Pannonica Adriat 2015 ;24(4):69-72

Pediatric Surgery Department, Assaf Harofe Medical Center, affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.

Introduction: We analyzed cases of ecthyma gangrenosum (EG) and "ecthyma-like" or "ecthyma-mimicking" cases of necrotic lesions of the skin to improve current definitions of these conditions.

Methods: The retrospective analysis compared 28 cases of lesions (from 2001 to June 2015) that were identified as EG. Age, sex, lesion location, time from macule to ulcer, underlying diseases, number of lesions per patient, wound bacterial culture, blood culture, and immune status served as variables for analysis and comparison. Read More

Indian J Ophthalmol 2015 Oct;63(10):798-800

Department of Ophthalmology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India.

Ecthyma gangrenosum (EG) is a cutaneous infection which usually occurs in immunocompromised patients. We report a case of EG of the eyelid treated with escharotomy and skin grafting, highlighting the importance of surgical management. A 2-year-old Asian Indian female presented to us with right upper lid edema with a large necrotic area. Read More

Arch Plast Surg 2015 Nov 16;42(6):805-7. Epub 2015 Nov 16.

Department of Plastic and Reconstructive Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.

Indian Dermatol Online J 2015 Sep-Oct;6(5):336-8

Department of Clinical Microbiology and Infectious Diseases, Ondokuz Mayis Universty, Samsun, Turkey.

Ecthyma gangrenosum is a rare skin infection caused by Pseudomonas aeruginosa. It is usually seen in immunocompromised and critically ill patients. We report one such case in a previously healthy 20-year old male. Read More

Indian Pediatr 2015 Oct;52(10):896-8

Department of Pediatric Surgery, Dr BC Roy, Post Graduate Institute of Pediatric Sciences (PGIPS); and *Department of Pathology, Institute of Postgraduate Medical Education and Research (IPGMR), Kolkata, West Bengal, India. Correspondence to: Dr Pankaj Halder, SarodaPalli, PanchanonTala, Baruipur, Kolkata 700 144, West Bengal, India.

Background: Outcome of pseudomonas enteric fever is unpredictable as multiple systemic lethal complications occur abruptly.

Case Characteristics: A 9-month-old girl with multiple ileal perforations, leukocoria, ecthyma gangrenosum, hemiplegia and a perforated ulcer in the soft palate. Blood culture suggested Pseudomonas aeruginosa infection. Read More

Pediatr Dermatol 2015 Nov-Dec;32(6):e259-62. Epub 2015 Oct 13.

Department of Dermatology, University of California at San Diego, San Diego, California.

We describe a previously healthy 15-month-old girl who developed ecthyma gangrenosum (EG)-like lesions secondary to methicillin-sensitive Staphylococcus aureus (MSSA). Her systemic symptoms and negative blood cultures suggested MSSA toxin-mediated effects. When toxin-mediated systemic symptoms accompany such lesions, pathogens other than Pseudomonas aeruginosa should be considered. Read More

Pediatr Dermatol 2015 Jul-Aug;32(4):e179-80. Epub 2015 May 4.

Department of Dermatology, Fattouma Bourguiba Hospital, Monastir, Tunisia.

Ecthyma gangrenosum is a characteristic lesion of Pseudomonas aeruginosa sepsis in immunocompromised patients. Only eight cases of ecthyma gangrenosum caused by Escherichia coli have been reported. We report a case of ecthyma gangrenosum due to E. Read More

Actas Dermosifiliogr 2015 Jul-Aug;106(6):510. Epub 2015 Apr 23.

Unidad de Gestión Clínica Dermatología Médico Quirúrgica y Venereología, Hospital Universitario Virgen de las Nieves, Granada, España.