Ecthyma Gangrenosum

Etiology


Diagnosis

  • Skin Biopsy: quite characteristic, showing bacterial invasion of the media and adventitia of veins deep in the dermis (intima and lumen of the vein are spared)

Clinical

PYODERM DIFF

ECTHYMA

  • Begins as red/purpuric macular rash (see Purpura, [[Purpura]])
  • Progresses to indurated vesicles
  • Progresses to bullous, pustular, or hemorrhagic lesions
  • Gangrenous ulcers with surrounding erythema: may occur within 12-24 hrs
    • Usually less than 10 lesions are present, most often found in the gluteal or perineal regions, but also appearing on the extremities, trunk, and face in descending order, respectively

Treatment

  • Aminoglycoside + Antipseudomonal Penicillin:
  • Ceftazidime
  • Imipenem
  • Surgical Debridement: often required

Prognosis

  • Related to Absolute Neutrophil Count: the lower the absolute neutrophil count (ANC), the poorer the prognosis
    • Patients with an ANC < 500 cells/mm3 (0.5 x 109/L) rarely survive

References

  • xxx