title: A Fatal Case of "Bullous Erysipelas-like" Pseudomonas Vasculitis.
abstract: Erysipelas is a generally benign superficial bacterial skin infection, and its bullous form constitutes a rare and more severe variant. We describe the first and fatal case of "bullous erysipelas-like" septic vasculitis due to Pseudomonas bacteremi. A 69-year-old Chinese man presenting with diarrhea and septic shock initially began to rapidly develop sharply defined erythematous plaques with non-hemorrhagic bullae over his lower limbs. Culture of the aspirate from the bullae was positive for Pseudomonas aeruginosa. This was also consistent with his blood cultures showing Pseudomonas bacteremia. Histology of the skin lesion showed microthrombi and neutrophilic infiltrates in blood vessels with Gram-negative bacilli extruding from the vessel walls, characteristic of septic vasculitis. The bullous erysipelas-like lesions seen in this patient represents a rare manifestation of both septic vasculitis and Pseudomonas infection.
authors.affiliation: Department of General Medicine, University Medicine Cluster, National University of Singapore, Singapore, Asia.
authors.forename: Sam Shiyao
authors.initials: SS
authors.lastname: Yang
authors.affiliation: Department of General Medicine, University Medicine Cluster, National University of Singapore, Singapore, Asia.
authors.forename: Nisha Suyien
authors.initials: NS
authors.lastname: Chandran
authors.affiliation: Department of Pathology, Yong Loo Lin School of Medicine, National University Health System, National University of Singapore, Singapore, Asia.
authors.forename: Jing Xiang
authors.initials: JX
authors.lastname: Huang
authors.affiliation: Department of Pathology, Yong Loo Lin School of Medicine, National University Health System, National University of Singapore, Singapore, Asia.
authors.forename: Kong-Bing
authors.initials: KB
authors.lastname: Tan
authors.affiliation: Department of General Medicine, University Medicine Cluster, National University of Singapore, Singapore, Asia.
authors.forename: Derrick Chen-Wee
authors.initials: DC
authors.lastname: Aw
keywords: Bullous erysipelas; leukocytoclastic vasculitis; septic vasculitis