Allergy Asthma Respir Dis.  2018 Jul;6(4):229-233. 10.4168/aard.2018.6.4.229.

Ecthyma gangrenosum and agranulocytosis in a previously healthy 12-month-old girl: Report of 1 case with a literature review

• Yoon JS
• Kim DH
• Lee SJ
• Bang HH
• Bae SM
• Park KB
• Lee SY
• Jung KJ
• Choi YJ
• Lee HJ
• Park JS

• KMID: 2417851
• DOI: http://doi.org/10.4168/aard.2018.6.4.229

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.

Keyword

Ecthyma gangrenosum; Agranulocytosis; Pseudomonas aeruginosa

MeSH Terms

Agranulocytosis*
Bacteremia
Child
Ecthyma*
Female*
Humans
Infant*
Influenza, Human
Pseudomonas aeruginosa
Rhinovirus
Scrub Typhus
Sepsis
Skin
Skin Manifestations
Ulcer
Wounds and Injuries

Figure

• 

  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 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. 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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