Ecthyma gangrenosum in pediatrics

JUAN ROJAS (1)

JUAN LOPEZ (2)

YULY MUÑOZ (2)

GUILLERMO GONZALEZ (3)

1. Pediatric Infectious Diseases Fellowship Program. University El Bosque/ University Libre sectional Cali. Colombia, South America.

2. Physician. University Libre sectional Cali, Colombia, South America.3. Pediatric dermatologist. Club Noel Children´s Hospital. University Libre sectional Cali, Colombia, South America.

IntroductionEtiologyClinical ManifestationsHistologic findingsDifferential diagnosis Treatment

Introduction Ecthyma gangrenosum (EG) is a rare infection of the

skin

Lesion caused by P. aeruginosa Other types of bacteria: S. aureus or beta hemolytic group

Often associated: Primary and secondary immunodeficiency

Qualitative and quantitative neutrophil defects

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Introduction Mortality: 40%-75% of immunologically

compromised individuals

Characterized by black eschars on an erythematous base

Diagnosis: Symptoms Cultures and skin biopsies

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Etiology

The most common pathogen: P. aeruginosa

A. hydrophila, S. aureus, S. marcescens, E. coli, K. pneumoniae, N. meningitidis, V. vulnificus, B. cepacia

Fungi: Fusarium sp, Candida sp, Mucor and Aspergillus sp

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Clinical Manifestations

Hemorrhagic bullae or necrotic ulcers that have progressed from painless macules or papules

Often the presenting lesion will exhibit an erythematous halo

Depending on the extent of infection and immune status: The patient may also be febrile with other constitutional

symptomsDermatology Online Journal 2012; 18 (3): 3

Girl: 5 years old Initially presented chickenpox and then infection

with S. aureus EG

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A, B, C, D: Erosions and deep ulcers, with serous and hematic crusts, necrotic background

Treatment: acyclovir, clindamycin and cefepime

Clinical case

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A, B, C: erythematous papules and macules with irregular borders

Exudating deep, blackish eschar surrounded by

extendedulceration and erythema

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Necrotic skin lesion with surrounding erythema and

dilated veins

Arch Dis Child Fetal Neonatal 2011; 96 (4): 1

Erythema, nodules, bulla, and ulcers with necrosison the right femoribus internus

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Initial presentation Wound at 2 months

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Histologic findings

Necrotizing vasculitis in which the media and adventitia of the vascular wall are invaded, but the intima is spared

Singapore Med J. 2006; 47: 1080Dermatology Online Journal 2012; 18 (3): 3

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Differential diagnosis

Bacterial cellulitis

Insect bites In the early, hyperaemic phase

Deep group α β-haemolytic Streptococci impetigo

Burns In the late, eschar-necrotising phase

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Treatment

Empirical antimicrobial therapy: Anti-Pseudomonal penicillins and aminoglycosides

Adjusted on the basis of culture results

Should be started

Pediatric Dermatology 2011; 28 (2): 1-3 Arch Dis Child 2015;100:54–56

Acta Pædiatrica 2015; 104:134–138

TreatmentDebridement

Assessment of immune functionFull blood count and peripheral blood smearHIV serologyImmunoglobulin levels Neutrophil function tests

Pediatric Dermatology 2011; 28 (2): 1-3 Arch Dis Child 2015;100:54–56

Acta Pædiatrica 2015; 104:134–138