title: Necrotizing cellulitis with multiple abscesses on the leg caused by Serratia marcescens.
abstract: Serratia marcescens is an unusual cause of severe skin infection initially described in immunocompromised patients. We report a case of necrotizing cellulitis of the leg caused by S marcescens in a 68-year-old woman with diabetes mellitus and a history of chronic lymphoedema of the leg. We reviewed the literature and found 49 cases of severe skin infections from S marcescens that included 20 cases of necrotizing fasciitis (NF) as well as 29 cases of severe skin infections without NF (non-NF cases). Patients were immunocompromised in 59% to 70% of cases. The mortality rate was high in NF cases (60%) versus non-NF cases (3%). Surgery was required in 95% of NF cases and in 24% of non-NF cases. The other clinical manifestations of S marcescens skin infection reported in the literature included disseminated papular eruptions in patients infected with human immunodeficiency virus with folliculitis on the trunk. Serratia marcescens is naturally resistant to amoxicillin alone and amoxicillin associated with clavulanic acid. Broad-spectrum antibiotics are indicated to treat S marcescens skin infections, and surgery should be promptly considered in cases of severe skin infections if appropriate antibiotic therapy does not lead to rapid improvement.
authors.affiliation: Department of Dermatology, Saint Louis Hospital and Université Paris Diderot, Sorbonne Paris Cité, AP-HP, France.
authors.forename: Estelle
authors.initials: E
authors.lastname: Hau
authors.affiliation: Department of Dermatology, Saint Louis Hospital and Université Paris Diderot, Sorbonne Paris Cité, AP-HP, France.
authors.forename: Jean-David
authors.initials: JD
authors.lastname: Bouaziz
authors.affiliation: Department of Infectious Diseases, Saint Louis Hospital and Université Paris Diderot, Sorbonne Paris Cité, AP-HP, France.
authors.forename: Matthieu
authors.initials: M
authors.lastname: Lafaurie
authors.affiliation: Department of Dermatology, Saint Louis Hospital and Université Paris Diderot, Sorbonne Paris Cité, AP-HP, France.
authors.forename: Anne
authors.initials: A
authors.lastname: Saussine
authors.affiliation: Department of Plastic Surgery, Saint Louis Hospital and Université Paris Diderot, Sorbonne Paris Cité, AP-HP, France.
authors.forename: Vincent
authors.initials: V
authors.lastname: Masson
authors.affiliation: Department of Plastic Surgery, Saint Louis Hospital and Université Paris Diderot, Sorbonne Paris Cité, AP-HP, France.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Rausky
authors.affiliation: Department of Dermatology, Saint Louis Hospital and Université Paris Diderot, Sorbonne Paris Cité, AP-HP, France.
authors.forename: Martine
authors.initials: M
authors.lastname: Bagot
authors.affiliation: Department of Dermatology, Saint Louis Hospital and Université Paris Diderot, Sorbonne Paris Cité, AP-HP, France.
authors.forename: Fabien
authors.initials: F
authors.lastname: Guibal
mesh_terms: D000038:Abscess / Q000382:microbiology / Q000473:pathology; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D002481:Cellulitis / Q000175:diagnosis* / Q000382:microbiology / Q000473:pathology; D019115:Fasciitis, Necrotizing / Q000175:diagnosis* / Q000382:microbiology / Q000473:pathology; D005260:Female; D006801:Humans; D007866:Leg; D016868:Serratia Infections / Q000175:diagnosis* / Q000382:microbiology / Q000473:pathology; D012706:Serratia marcescens / Q000302:isolation & purification*
chemical_list: D000900:Anti-Bacterial Agents