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Allergy Asthma Respir Dis. 2018 Jul;6(4):229-233. Korean.
Published online July 30, 2018.  https://doi.org/10.4168/aard.2018.6.4.229
© 2018 The Korean Academy of Pediatric Allergy and Respiratory Disease; The Korean Academy of Asthma, Allergy and Clinical Immunology
Ecthyma gangrenosum and agranulocytosis in a previously healthy 12-month-old girl: Report of 1 case with a literature review
Ji Soo Yoon,1 Dong Hyun Kim,1 Seung Ju Lee,1 Hyun Ho Bang,1 Sun Mi Bae,1 Kyeong Bae Park,1 Sung Yul Lee,2 Ki Jin Jung,3 Young Jin Choi,4 Hyun Jung Lee,5 and Joon Soo Park1
1Department of Pediatrics, Soonchunhyang Unversity College of Medicine, Cheonan, Korea.
2Department of Dermatology, Soonchunhyang Unversity College of Medicine, Cheonan, Korea.
3Department of Orthopedic Surgery, Soonchunhyang Unversity College of Medicine, Cheonan, Korea.
4Department of Clinical Laboratory Medicine, Soonchunhyang Unversity College of Medicine, Cheonan, Korea.
5Department of Emergency Medicine, Soonchunhyang Unversity College of Medicine, Cheonan, Korea.

Correspondence to: Joon Soo Park. Department of Pediatrics, Soonchunhyang University Cheonan Hospital, Soonchunhyang Unversity College of Medicine, 31 Suncheonhyang 6-gil, Dongnam-gu, Cheonan 31151, Korea. Tel: +82-41-570-2163, Fax: +82-41-572-4996, Email: pjstable@schmc.ac.kr
Received October 26, 2017; Revised January 11, 2018; Accepted January 16, 2018.

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/).


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 previously 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 Tsutsugamushi disease and initiate appropriate empiric antipseudomonal antibiotic treatment, and to evaluate for possible immunodeficiency, even in a healthy child.

Keywords: Ecthyma gangrenosum; Agranulocytosis; Pseudomonas aeruginosa

Figures


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.
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Fig. 2
(A) A black eschar in central area surrounded by erythematous rim reappeared 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.
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Fig. 3
Surgical debridement was performed on the 5th admission day.
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Fig. 4
Changes in neutrophil count (ANC) by date and then month. GCSF, granulocyte colony stimulating factor; I&D, incision and drainage.
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Tables

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