Ecthyma gangrenosum with Pseudomonas aeruginosa bacteremia in an immunocompromised patient

Abstract

Abstract Rationale: Ecthyma gangrenosum is an uncommon cutaneous manifestation and recognized for its association with Pseudomonas aerugninosa sepsis in immunocompromised patients, particularly if there is neutropenia. These lesions follow a certain pattern of presentation, from erythematous nodules to necrotizing ulcers with surrounding erythema. Patient concerns: We describe a case of an immunocompromised woman with recent breast cancer diagnosis, under chemotherapy treatment, who on admission presented painful erythematous nodules on her right thigh with 5 days of evolution and hemodynamically stable. The computed tomography scan of chest, abdomen, and pelvis showed nodular areas of densification of the subcutaneous tissue predominantly in the abdominal wall and nodular peripheral lesions in the pulmonary parenchyma, with recent onset, suggestive of possible septic embolization. Diagnosis: The diagnosis of ecthyma gangrenosum was confirmed after the isolation of Pseudomonas aeruginosa from the blood and wound culture samples, while a punch biopsy excluded other possible etiologies. Interventions: The patient completed 30 days of antibiotherapy, initially with piperacillin/tazobactam that was narrowed after 14 days of treatment to ciprofloxacin. Outcomes: Favorable evolution with complete clinical resolution was observed after 3months. Lessons: The early recognition and the prompt treatment with broad spectrum empiric antibiotic are the key for a good outcome in patients with ecthyma gangrenosum.