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CASE REPORT
Year : 1991  |  Volume : 57  |  Issue : 4  |  Page : 192-193

Ecthyma gangrenosum with pseudomonas septicemia



Correspondence Address:
K Pavithran


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  Abstract 

Multiple lesions of ecthyma gangrenosum developing as specific cutaneous manifestation of pseudomonas septicemia is reported in a male. In spite of vigorous antibiotic therapy, he died of septicemic shock.


Keywords: Pseudomonas aeruginosa, Ecthyma gangrenosum, Septicemia


How to cite this article:
Pavithran K. Ecthyma gangrenosum with pseudomonas septicemia. Indian J Dermatol Venereol Leprol 1991;57:192-3

How to cite this URL:
Pavithran K. Ecthyma gangrenosum with pseudomonas septicemia. Indian J Dermatol Venereol Leprol [serial online] 1991 [cited 2019 Aug 21];57:192-3. Available from: http://www.ijdvl.com/text.asp?1991/57/4/192/3672


Pseudomonas aeruginosum, though causes little or no disease in a healthy per­son, in the debilitated as a secondary invader it may be fatal. Green nail syndrome, external otitis, toe-web infection and cellulitis are the common manifestations of cutaneous infection with this organism[1],[2] Ecthyma gangrenosum, first described by Barker in 1987,[3] and sub­sequently noted by others, is an early and pathognomonic lesion of pseudomonas septi­cemia[4],[5] It develops as a haemorrhagic bulla which rapidly becomes necrotic and ulcerative. Here, we report multiple lesions of ecthyma gangrenosum developing in a patient with pseudomonas septicemia.


  Case Report Top


A 42-year-old male, an addict to cannabis and who had above-knee amputation of both legs for thromboangitis obliterans 6 years back, was seen for multiple haemorrhagic blisters and necrotic areas on the thighs and buttocks of 5 days duration. Ten days prior to this he developed an ulcer on the left thigh following an injury. Alongwith the worsening of the ulcer he noticed the skin eruptions on the thighs and hands. Patient was febrile and toxic. There were multiple haemorrhagic blis­ters [Figure - 1] and necrotic, circular, punched-out ulcers on the thighs [Figure - 2], hands, buttocks and lower abdomen. A few purpuric lesions also were seen. There was an ulcer of 4x6 cm size, covered with greenish-yellow exudate on the left thigh. On the second day in the hospital he was confused and became more toxic with high fever, dyspnoea and hallucination. New lesions continued erupting.

Laboratory tests revealed leukocytosis (9400 cells lc mm) and a raised ESR (60mm first hr). Blood urea was 60mg%. Urinalysis, liver function tests and serum electrolytes were normal. Blood VDRL was negative. Smears taken from the necrotic ulcers showed many gram-negative bacilli. Culture of blood and blister fluid yielded growth of P. aeruginosa sensitive to gentamicin. In spite of vigorous antibiotic treatment, he developed signs and symptoms of gram-negative bacil­lary shock with hypotension, hypothermia, pallor and abdominal distention and he died on the fifth day in the hospital.


  Comments Top


Ecthyma gangrenosum is an uncommon skin lesion seen in this antibiotic era. Although petechial, purpuric and cellulitic lesions are also seen in pseudomonas septicemia, ecthyma gangrenosum is the truly diagnostic sign, permitting early recognition and treat­ment of the septicemia long before cultures can be helpful. The bacilli invade the walls, first of deep subcutaneous veins and later of superficial vessels at sites where ulcers form.[6] In our patient, the morphology of the skin le­sions were quite typical of ecthyma gangrenosum. The focus of infection in him appears to be the traumatic ulcer on the thigh. Ecthyma gangrenosum usually occurs in debilitated persons. Our patient had been an addict to cannabis for many years which might have impaired his ability to resist infec­tion. Further, the blood vessels of his limbs had already been damaged by thromboangitis obliterans. The application of various topical antibiotics over the ulcer prob­ably altered the flora of the skin, resulting in overgrowth of P-aeruginosa which easily en­tered the blood resulting in septicemia.

 
  References Top

1.Shellow WVR and Kopion BS : Green striped nails: Chromonychia due to Pseudomonas aeruginosa, Arch Dermatol, 1968; 97: 149-153.  Back to cited text no. 1    
2.Taplin D, Bassett DCJ and Mertz PM : Foot lesions associated with Pseudomonas cepacia, Lancet, 1971; 2: 568-571.  Back to cited text no. 2    
3.Barker LF : The clinical symptoms, bacteriologic findings, and postmortem appearances in cases of infection of human beings with the Bacillus pyocyaneus, J A M A, 1897; 29: 213-216.  Back to cited text no. 3    
4.Heffiner RW and Smith GF : Ecthyma gangrenosum in pseudomonas septicemia, Amer J Dis child, 1960; 99: 524-528.  Back to cited text no. 4    
5.Curtion JA, Petersdorf FG and Bennet IL Jr Pseudomonas bacteremia : Review of 91 cases, Ann Intern Med, 1961; 54 :1077-1107.  Back to cited text no. 5    
6.Dorff GJ, Geimer NF, Rosenthal DR et al Pseudomonas septicemia, Arch Intern Med, 1971; 128 : 591-595.  Back to cited text no. 6    


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[Figure - 1], [Figure - 2]

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