Abstract
Background and Aim: Ecthyma gangrenosum (EG) is a rare necrotic skin infection caused by Pseudomonas aeruginosa occurring on healthy skin mainly, but not exclusively, in immunocompromised patients. We report the case of EG of unusual presentation in a 12-month-old infant. Case Presentation: This was a 12-month-old male infant who was referred from a peripheral structure for the treatment of facial swelling associated with fever. In his antenatal and intra nasal history, there was a notion of hospitalization for 15 days for early neonatal infection and a delay in psychomotor development. The admission examination showed the fair general condition, hyperthermia at 39°C, tachycardia at 136 beats/minute, and polypnea at 48 cycles/minute. The weight-for-height index with a z-score of 3DS was also found. The dermatological examination at the entrance found an extensive brownish inflammatory tense infiltrated plaque taking the mandibular, submental, retro-auricular occipital regions rapidly evolving towards necrosis, a significant swelling predominant on the upper right eyelid preventing the opening of the associated eyes to mouth ulceration. Biological abnormalities were predominantly neutrophilic leukocytosis, elevated CRP, and elevated muscle enzymes. Microbiological examination of skin samples had isolated Pseudomonas aeruginosa. He had received antibiotic therapy, and a necrosectomy under general anesthesia. The evolution was favorable and he was discharged from the hospital on D26 of hospitalization. Conclusion: This observation is rare due to its location, its early onset, and non-neutropenic background.
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