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Abstract
Ecthyma gangrenosum (EG) is a rare skin manifestation which starts with a maculopapular eruption and followed by a necrotic ulcer covered with black eschar. EG usually occurs in immunosuppressed patients with Pseudomonas aeruginosa sepsis. We present a pre-viously healthy 12-month-old girl with EG by P. aeruginosa and agranulocytosis due to influenza A and then rhinovirus infection, without bacteremia. It is important for allergists to culture wound and differentiate EG from other skin disorders including Tsutsuga-mushi disease and initiate appropriate empiric antipseudomonal antibiotic treatment, and to evaluate for possible immunodeficiency, even in a healthy child.
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Fig. 1.
A 12-month-old girl had a round shaped skin lesion of a necrotic ulcer with surrounding erythematous rim at the Emergency Department on the 8th day.
Fig. 2.
(A) A black eschar in central area surrounded by erythematous rim reap-peared on the 9th day. Eschar had occurred on the 4th day of skin lesion. (B) A black eschar in central area surrounded by erythematous rim. Picture zoomed in panel A.
Fig. 4.
Changes in neutrophil count (ANC) by date and then month. GCSF, granulocyte colony stimulating factor; I&D, incision and drainage.
Table 1.
Summary of lab findings
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