Ravichander B1, Sayid Mohammed Muflih2, Ahirrao Varsha Suresh3

Ecthyma gangrenosum is a rare and invasive cutaneous infection caused by Pseudomonas aeruginosa in the majority of cases, typically affecting immunocompromised patients, particularly those with neutropenia. An 1-year-old male child was presented to Paediatric Department with multiple ulcers showing granulation tissue and eschar, biggest ulcer over the left buttock. A culture from the ecthyma lesion revealed the presence of Pseudomonas aeruginosa, but the results of repeated blood cultures were negative. The patient responded well to piperacillin + tazobactam to which the isolate was susceptible in vitro. Considering high rate of mortality, early diagnosis and prompt effective treatment is mandatory.
Ecthyma gangrenosum is a well-recognised, but uncommon cutaneous infection classically associated with P. aeruginosa bacteraemia and usually occurs in immunosuppressed patients.1 Ecthyma gangrenosum occurs in up to 6% of patients with systemic P. aeruginosa infection, but can also occur as a primary cutaneous infection by inoculation. Clinically, similar lesions may also develop as a result of infection with other agents such as S. aureus, A. hydrophila, Enterobacter spp., Proteus spp., Burkholderia cepacia, Serratia marcescens, Aspergillus spp., E. coli and Candida spp. The main site of ecthyma gangrenosum lesions is the gluteal or perineal region (57%).2 Although, this lesion can spread to other body sites. The typical lesion begins as a red or purpuric macule that vesiculates and then ulcerates. Patients with bacteraemia commonly have lesions in apocrine areas. EG was first described in association with Pseudomonas septicaemia by Barker in 1897.