title: Gangrenous, hemorrhagic, bullous cellulitis associated with pseudomonas aeruginosa in a patient with Waldenström's macroglobulinemia.
abstract: BACKGROUND
  Patients with Waldenström's macroglobulinemia may manifest several types of skin lesions. We present our experience with a patient with the disease that adds to the literature on the topic.
  
  
  METHODS
  A 57-year-old man with history of multiple sclerosis and Waldenström's macroglobulinemia was admitted to the intensive care unit in shock. His family members reported that the patient had complained of fever and the gradual development of gangrenous, hemorrhagic, bullous cellulitis lesions on the abdomen and lower extremities for 7 days prior to his admission to the hospital. Pseudomonas aeruginosa was isolated from fluid specimens collected from the cutaneous lesions. Appropriate antimicrobial treatment including continuous intravenous administration of meropenem (6 g every 24 h) led to the cure of the infection.
  
  
  CONCLUSIONS
  We postulate that the underlying Waldenström's macroglobulinemia contributed to the pathophysiology of the development of the rare skin manifestations of the infection observed in our patient.
authors.affiliation: Alfa Institute of Biomedical Sciences, 9 Neapoleos Street, Marousi, 151 23, Athens, Greece. m.falagas@aibs.gr
authors.forename: M E
authors.initials: ME
authors.lastname: Falagas
authors.forename: V D
authors.initials: VD
authors.lastname: Pappas
authors.forename: A
authors.initials: A
authors.lastname: Michalopoulos
mesh_terms: D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000627:therapeutic use; D002481:Cellulitis / Q000188:drug therapy / Q000382:microbiology* / Q000473:pathology*; D006801:Humans; D007262:Infusions, Intravenous; D008297:Male; D000077731:Meropenem; D008875:Middle Aged; D011552:Pseudomonas Infections / Q000188:drug therapy / Q000382:microbiology* / Q000473:pathology; D011550:Pseudomonas aeruginosa / Q000302:isolation & purification*; D013845:Thienamycins / Q000008:administration & dosage / Q000627:therapeutic use; D008258:Waldenstrom Macroglobulinemia / Q000150:complications*
chemical_list: D000900:Anti-Bacterial Agents; D013845:Thienamycins; D000077731:Meropenem