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A Rare Case of Ecthyma Gangrenosum Caused by Proteus vulgaris and Candida albicans in a Patient with Castleman Disease.

Lee YJ, Jung IO, Oh DY - Arch Plast Surg (2015)

View Article: PubMed Central - PubMed

Affiliation: Department of Plastic and Reconstructive Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.

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Ecthyma gangrenosum (EG) is an ulcerative pyoderma of the skin that extends into the dermis and subdermal tissue with necrotic changes, and is generally described as a round, deep, punched-out ulceration with a central black eschar surrounded by an erythematous halo... Our patient showed extensive lesions involving necrotic ulcerative changes on the lower abdomen and on the right upper arm... To the best of our knowledge, this was a rare case of EG associated with P. vulgaris and C. albicans... Moreover, a follow-up culture was taken and a tissue biopsy was obtained from the necrotic lesion... The previously noted organism, P. vulgaris, was found along with C. albicans... Nonbacteremic EG is considered to be the result of direct inoculation of the infected organism into the skin site... Nonbacteremic EG patients have a lower mortality rate of 16%, compared to 38%-96% for bacteremic EG patients... Several other diseases involving cutaneous ulceration resemble EG, such as ecthyma, pyoderma gangrenosum, and necrotizing fasciitis, which may cause EG-like ulcerations... For example, pyoderma gangrenous is treated with systemic immunosuppressive therapy, such as oral or intravenous pulse corticosteroids, and cyclosporine, which has harmful side effects... EG is typically found in immunocompromised individuals, most commonly in patients with a prior diagnosis of hematologic malignancies, and the prognosis depends on the patient's general health and immunological status... Due to prompt treatment with appropriate antibiotics and surgical debridement of all necrotizing tissues, septicemia was prevented and the patient was discharged from the hospital 31 days after admission... In conclusion, our case emphasizes that although EG is considered pathognomic for Pseudomonas aeruginosa, other pathogens, including fungal or viral organisms, should be considered.

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Abdominal computed tomography showed a subcutaneous emphysema without deep fascial enhancement.
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Figure 3: Abdominal computed tomography showed a subcutaneous emphysema without deep fascial enhancement.

Mentions: A 57-year-old woman presented to the emergency department with multiple skin lesions involving her trunk and upper extremities. Six months previously, the patient had developed a perianal fistula and a colostomy was performed. The patient noticed an erythematous skin rash on her right arm that spread to her trunk and gradually progressed into necrotic bullae. Her past history indicated that she had been diagnosed with MCD three years previously, was taking immunosuppressive agents with oral steroids, and had no history of taking antibiotics. The patient had a mild temperature of 38.0℃, and the laboratory findings showed leukopenia with thrombocytopenia. A skin examination revealed a deep punched-out ulceration on the abdomen near the colostomy site and a large, palm-sized eschar formation with an erythematous halo on her right arm (Figs. 1, 2). Under suspicion of EG, the patient received cefepime to treat the most likely cause, Pseudomonas aeruginosa infection. Superficial wound swabs and tissue for Gram staining and culture were obtained before antibiotic treatment, and Gram-negative bacilli were found and identified as P. vulgaris. Abdominal computed tomography showed subcutaneous emphysema without deep fascial enhancement (Fig. 3).


A Rare Case of Ecthyma Gangrenosum Caused by Proteus vulgaris and Candida albicans in a Patient with Castleman Disease.

Lee YJ, Jung IO, Oh DY - Arch Plast Surg (2015)

Abdominal computed tomography showed a subcutaneous emphysema without deep fascial enhancement.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4660003&req=5

Figure 3: Abdominal computed tomography showed a subcutaneous emphysema without deep fascial enhancement.
Mentions: A 57-year-old woman presented to the emergency department with multiple skin lesions involving her trunk and upper extremities. Six months previously, the patient had developed a perianal fistula and a colostomy was performed. The patient noticed an erythematous skin rash on her right arm that spread to her trunk and gradually progressed into necrotic bullae. Her past history indicated that she had been diagnosed with MCD three years previously, was taking immunosuppressive agents with oral steroids, and had no history of taking antibiotics. The patient had a mild temperature of 38.0℃, and the laboratory findings showed leukopenia with thrombocytopenia. A skin examination revealed a deep punched-out ulceration on the abdomen near the colostomy site and a large, palm-sized eschar formation with an erythematous halo on her right arm (Figs. 1, 2). Under suspicion of EG, the patient received cefepime to treat the most likely cause, Pseudomonas aeruginosa infection. Superficial wound swabs and tissue for Gram staining and culture were obtained before antibiotic treatment, and Gram-negative bacilli were found and identified as P. vulgaris. Abdominal computed tomography showed subcutaneous emphysema without deep fascial enhancement (Fig. 3).

View Article: PubMed Central - PubMed

Affiliation: Department of Plastic and Reconstructive Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.

AUTOMATICALLY GENERATED EXCERPT
Please rate it.

Ecthyma gangrenosum (EG) is an ulcerative pyoderma of the skin that extends into the dermis and subdermal tissue with necrotic changes, and is generally described as a round, deep, punched-out ulceration with a central black eschar surrounded by an erythematous halo... Our patient showed extensive lesions involving necrotic ulcerative changes on the lower abdomen and on the right upper arm... To the best of our knowledge, this was a rare case of EG associated with P. vulgaris and C. albicans... Moreover, a follow-up culture was taken and a tissue biopsy was obtained from the necrotic lesion... The previously noted organism, P. vulgaris, was found along with C. albicans... Nonbacteremic EG is considered to be the result of direct inoculation of the infected organism into the skin site... Nonbacteremic EG patients have a lower mortality rate of 16%, compared to 38%-96% for bacteremic EG patients... Several other diseases involving cutaneous ulceration resemble EG, such as ecthyma, pyoderma gangrenosum, and necrotizing fasciitis, which may cause EG-like ulcerations... For example, pyoderma gangrenous is treated with systemic immunosuppressive therapy, such as oral or intravenous pulse corticosteroids, and cyclosporine, which has harmful side effects... EG is typically found in immunocompromised individuals, most commonly in patients with a prior diagnosis of hematologic malignancies, and the prognosis depends on the patient's general health and immunological status... Due to prompt treatment with appropriate antibiotics and surgical debridement of all necrotizing tissues, septicemia was prevented and the patient was discharged from the hospital 31 days after admission... In conclusion, our case emphasizes that although EG is considered pathognomic for Pseudomonas aeruginosa, other pathogens, including fungal or viral organisms, should be considered.

No MeSH data available.


Related in: MedlinePlus