Ecthyma gangrenosum in a patient with toxic epidermal necrolysis.
Toxic epidermal necrolysis and Stevens-Johnson syndrome are a spectrum of disease characterized by a delayed hypersensitivity reaction that involves the skin and mucous membranes and typically is associated with either recent upper respiratory infection or with certain medications. Ecthyma gangrenosum is a rare necrotizing vasculitis that most commonly affects immunocompromised and burn patients and is often a sequela of Pseudomonas aeruginosa bacteremia. The cutaneous lesions of ecthyma gangrenosum are characterized by an erythematous halo surrounding a dark gray or black nodule. P. aeruginosa preferentially invades the venules, resulting in secondary thrombosis of the arterioles, tissue edema, and separation of the epidermis. Management of ecthyma gangrenosum includes systemic treatment with antipseudomonal antibiotics and débridment of the lesions, as well as improving the patient's immune status if possible. We present a case of a patient admitted to the burn unit for toxic epidermal necrolysis who developed pseudomonal bacteremia with ecthyma gangrenosum.
Downey
Douglas M
DM
Department of Surgery, Wright State University School of Medicine, Dayton, Ohio, USA.
O'Bryan
Meghan C
MC
Burdette
Steve D
SD
Michael
Johnson R
JR
Saxe
Jonathan M
JM
D000890:Anti-Infective Agents / Q000009:adverse effects; D016470:Bacteremia / Q000382:microbiology*; D003646:Debridement; D004473:Ecthyma / Q000150:complications* / Q000628:therapy; D017809:Fatal Outcome; D005260:Female; D005734:Gangrene / Q000382:microbiology* / Q000628:therapy; D006801:Humans; D008875:Middle Aged; D011550:Pseudomonas aeruginosa / Q000302:isolation & purification; D013211:Staphylococcus aureus / Q000302:isolation & purification; D013262:Stevens-Johnson Syndrome / Q000150:complications* / Q000628:therapy; D013420:Sulfamethoxazole / Q000009:adverse effects; D014295:Trimethoprim / Q000009:adverse effects
D000890:Anti-Infective Agents; D014295:Trimethoprim; D013420:Sulfamethoxazole