Ecthyma gangrenosum (EG) is a recognized cutaneous infection commonly associated with Pseudomonas aeruginosa bacteremia. It typically occurs in patients who are septic and severely immunocompromised. Clinical presentation characteristically begins as an erythematous or hemorrhagic vesicle or bulla, which evolves into a necrotic ulcer with eschar and surrounding erythema. This was first described in association with Pseudomonas septicemia by Barker in 1897 and was later given the name “ecthyma gangrenosum” by Hitschmann and Kreibich.1
Clinical photograph of our patient's initial presentation with eschar and surrounding erythema.
Biopsy specimen demonstrating dermal necrosis with sparse lymphocytic infiltrate and vasculitis with associated thrombi (hematoxylin-eosin, original magnification ×20).
Manifestations demonstrating rapid progression of disease despite intravenous antipseudomonal antibiotic regimen 5 days after the photograph in Figure 1 was taken.
Computed tomographic scan with contrast demonstrating fat stranding and edema.
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