|Year : 1991 | Volume
| Issue : 4 | Page : 192-193
Ecthyma gangrenosum with pseudomonas septicemia
Source of Support: None, Conflict of Interest: None
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
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, Ecthyma gangrenosum, first described by Barker in 1987, and subsequently noted by others, is an early and pathognomonic lesion of pseudomonas septicemia, 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|| |
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|| |
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. 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|| |
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|2.||Taplin D, Bassett DCJ and Mertz PM : Foot lesions associated with Pseudomonas cepacia, Lancet, 1971; 2: 568-571. |
|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. |
|4.||Heffiner RW and Smith GF : Ecthyma gangrenosum in pseudomonas septicemia, Amer J Dis child, 1960; 99: 524-528. |
|5.||Curtion JA, Petersdorf FG and Bennet IL Jr Pseudomonas bacteremia : Review of 91 cases, Ann Intern Med, 1961; 54 :1077-1107. |
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[Figure - 1], [Figure - 2]
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