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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.

No MeSH data available.


A completely healed lesion on the right arm of the patient, after surgical debridement and local flap coverage with a split-thickness skin graft were performed.
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Figure 5: A completely healed lesion on the right arm of the patient, after surgical debridement and local flap coverage with a split-thickness skin graft were performed.

Mentions: Surgical debridement and wound irrigation were performed to remove the necrotic tissue. 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. Appropriate antibiotic and antifungal treatment was initiated, including ceftazidime and teicoplanin with fluconazole. After changing antibiotics and adding an antifungal agent, the lesions gradually improved. The erythematous changes around the eschar subsided and the central necrosis stopped progressing. A week after surgical debridement reconstruction was planned, local flap coverage with a split-thickness skin graft was performed to cover the defect. The patient completed three weeks of treatment with intravenous antibiotic and antifungal agents with no signs of fever, and the wound healed completely, with no complications (Figs. 4, 5).


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)

A completely healed lesion on the right arm of the patient, after surgical debridement and local flap coverage with a split-thickness skin graft were performed.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 5: A completely healed lesion on the right arm of the patient, after surgical debridement and local flap coverage with a split-thickness skin graft were performed.
Mentions: Surgical debridement and wound irrigation were performed to remove the necrotic tissue. 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. Appropriate antibiotic and antifungal treatment was initiated, including ceftazidime and teicoplanin with fluconazole. After changing antibiotics and adding an antifungal agent, the lesions gradually improved. The erythematous changes around the eschar subsided and the central necrosis stopped progressing. A week after surgical debridement reconstruction was planned, local flap coverage with a split-thickness skin graft was performed to cover the defect. The patient completed three weeks of treatment with intravenous antibiotic and antifungal agents with no signs of fever, and the wound healed completely, with no complications (Figs. 4, 5).

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.