title: Multiple skin ulcers due to Serratia marcescens in a immunocompetent patient.
abstract: Serratia marcescens is a species of gram negative bacillus, classified as a member of the Enterobacteriaceae, mainly involved in opportunistic infections, particulary in the hospital environment. Cutaneous infections have rarely reported in literature and are predominantly observed in elderly or in immunocompromised patients. The clinical manifestations of skin infections include granulomatous lesions, necrotizing fasciitis, nodules, cellulitis, ulcers, dermal abscesses. Infections caused by S. marcescens may be difficult to treat because of resistance to a variety of antibiotics, including ampicillin and first and second generation cephalosporins. Aminoglycosides have good activity against S. marcescens, but resistant strains have also been described. We report a very intriguing case of S. marcescens infection, in an immunocompetent 18-year-old man, causing multiple rounded ulcers of varying sizes, along with few pustular lesions that both clinically and histopathologically mimic a pyoderma gangrenosum (PG). This is a non infectious neutrophilic skin disorder, characterized by painful and rapidly progressing skin ulceration. According to our experience, we would strongly recommend to perform cultures of multiple skin ulcers resembling PG, even in young healthy patients, to ensure correct diagnosis and treatment, since resistant to conventional antibiotics bacteria such as S. marcescens may be the cause of these lesions, like in the case here reported.
authors.affiliation: Operative Unit of Dermatology, NESMOS Department Faculty of Medicine and Psychology, "Sapienza" Sant'Andrea Hospital, Rome, Italy - cpranteda@hotmail.com.
authors.forename: M
authors.initials: M
authors.lastname: Carlesimo
authors.forename: A
authors.initials: A
authors.lastname: Pennica
authors.forename: M
authors.initials: M
authors.lastname: Muscianese
authors.forename: U
authors.initials: U
authors.lastname: Bottoni
authors.forename: C
authors.initials: C
authors.lastname: Abruzzese
authors.forename: M
authors.initials: M
authors.lastname: Giubettini
authors.forename: G
authors.initials: G
authors.lastname: Pranteda
authors.forename: G
authors.initials: G
authors.lastname: Pranteda
mesh_terms: D000293:Adolescent; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D002939:Ciprofloxacin / Q000627:therapeutic use*; D003937:Diagnosis, Differential; D006801:Humans; D007121:Immunocompetence; D008297:Male; D017511:Pyoderma Gangrenosum / Q000175:diagnosis; D016868:Serratia Infections / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy*; D012706:Serratia marcescens / Q000302:isolation & purification*; D012883:Skin Ulcer / Q000175:diagnosis / Q000188:drug therapy* / Q000382:microbiology*; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents; D002939:Ciprofloxacin