Ecthyma Gangrenosum in Children With Cancer: Diagnosis at a Glance: A Retrospective Study From the Infection Working Group of Italian Pediatric Hematology Oncology Association.

Abstract

BACKGROUND:

To depict ecthyma gangrenosum (EG) clinical presentation and evolution in a large multicenter pediatric retrospective collection of children with malignancies or bone marrow failure syndromes, to facilitate early diagnosis.

METHODS:

EG episodes diagnosed in the period 2009-2019 were identified by a retrospective review of clinical charts at centers belonging to the Italian Pediatric Hematology Oncology Association.

RESULTS:

Thirty-eight cases of EG occurring in children (male/female 16/22; median age 5.2 years) with hematologic malignancy (29), allogeneic stem cell transplantation (2) or relapsed/refractory solid tumor (3) were collected. The involved sites were: perineal region (19), limbs (10), trunk (6), head and the iliac crest (3). Bacteremia was present in 22 patients. Overall, the germs isolated were Pseudomonas aeruginosa (30), Stenotrophomonas maltophilia (3) and Escherichia coli (1); 31% of them were multidrug-resistant. All patients received antibacterial treatment, while surgery was performed in 24 patients (63.1%). Predisposing underlying conditions for EG were severe neutropenia (97.3%), corticosteroid treatment (71%) and iatrogenic diabetes (23.7%). All patients recovered, but EG recurred in 5 patients. Nine patients (24%) showed sequelae (deep scars, with muscle atrophy in 2). Four patients (10.5%) died, 1 due to relapse of EG with Carbapenem-resistant Enterobacteriaceae co-infection and 3 due to the progression of the underlying disease.

CONCLUSIONS:

EG requires early recognition and a proper and timely treatment to obtain the recovery and to avoid larger necrotic lesions, eventually evolving in scarring sequelae.

• Authors: Paola Muggeo, Daniele Zama, Nunzia Decembrino, Daniela Onofrillo, Stefano Frenos, Antonella Colombini, Katia Perruccio, Elisabetta Calore, Nagua Giurici, Monica Ficara, Milena La Spina, Rosamaria Mura, Raffaella De Santis, Nicola Santoro, Simone Cesaro
• Journal: The Pediatric infectious disease journal (Pediatr Infect Dis J) Vol. 41 Issue 3 Pg. 238-242 (03 01 2022) ISSN: 1532-0987 [Electronic] United States
• PMID: 34694251 (Publication Type: Journal Article)
• Copyright: Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.

Chemical References

• Anti-Bacterial Agents

Topics

• Adolescent
• Anti-Bacterial Agents (therapeutic use)
• Bacteremia (microbiology)
• Child
• Child, Preschool
• Ecthyma (complications, diagnosis, drug therapy, microbiology)
• Escherichia coli (isolation & purification)
• Escherichia coli Infections (drug therapy)
• Female
• Hematology (methods)
• Humans
• Infant
• Italy
• Male
• Neoplasm Recurrence, Local (complications)
• Neoplasms (complications)
• Neutropenia (complications)
• Pseudomonas Infections
• Pseudomonas aeruginosa (isolation & purification)
• Retrospective Studies
• Stenotrophomonas maltophilia (isolation & purification)