Ecthyma Gangrenosum is a manifestation of
Pseudomonas Aeruginosa infection, usually occurring in immunocompromised patients, which can be associated with Pseudomonas Aeruginosa
bacteremia with potentially lethal outcome. The clinical appearance is of an inflammatory cutaneous lesion with a central necrotic spot; the lesion then rapidly progresses to a gangrenous
ulcer with a gray-black eschar extending in the deep soft tissues. Treatment of
Ecthyma Gangrenosum includes both aggressive systemic
antibiotic therapy and
surgical procedures. A 2-year-old girl affected by B-cell precursor
acute lymphoblastic leukemia was admitted to our hospital for suspected
sepsis; the diagnosis was later confirmed by blood cultures positive for Pseudomonas Aeruginosa. In the days following the diagnosis, the patient developed a necrotic lesion of the right gluteal area consistent with
Ecthyma Gangrenosum. Aggressive surgical
debridement was then performed, followed by
negative-pressure wound therapy and reconstruction with dermal substitute and autologous skin graft, which were successful.
Ecthyma Gangrenosum is a potentially lethal condition affecting especially immunocompromised patients; aggressive medical treatment with combination
antibiotic therapy is warranted and multiple
surgical procedures, including extensive surgical
debridement and diverting
colostomy, are needed. Various reconstructive techniques have been reported in the literature, although no gold-standard can be established to date. Since
Ecthyma Gangrenosum lesions are characterized by the presence of both high inflammatory activity due
Pseudomonas infection and extensive tissue loss, the association of negative-pressure
therapy and dermal substitutes implant seem to have a rationale in the surgical treatment of
Ecthyma Gangrenosum and should therefore be considered.