Ecthyma gangraenosum L08.4

Author: Prof. Dr. med. Peter Altmeyer

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Last updated on: 14.06.2022

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Dermatitis gangraenosa infantum; ecthyma cachectoricum; Ecthyma gangraenosum terebrans; ecthyma terebrans; Gangraena multiplex cachecticorum; varicella gangraenosa

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Septic, highly febrile clinical picture with painful, initially furunculoid, then torpidly decaying, abscessing, highly red infiltrates, usually due to intercurrent Pseudomonas sepsis. Patients with acquired or congenital (see primary immunodeficiencies) immunodeficiencies are affected.

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In a larger cross-sectional study of 167 cases, P. aeruginosa was detected in 123 cases (73.65%), septicemia in 72 patients (58.5%). Another bacterial etiology(E.coli, Proteus) was detected in 29 cases (17.35 %). Fungi (?) detected in 15 cases (9 %) (Vaiman M et al. 2015)....

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The generally accepted definition of ecthyma gangrenosum (EG) is that this condition is pathognomonic for Pseudomonas septicemia (Pseudomonas aeruginosa) and usually occurs in immunocompromised patients.

Note: The vast majority of publishers make the diagnosis of "ecthyma gangraenosum" only when there is evidence of Pseudomonas infection.

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Especially in immunodeficient infants or young children; also in long-term immunocompromised (e.g., organ transplanted) adults or debilitated elderly.

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The disease mainly affects the armpits and the anogenital region; arms, legs, trunk and face are less frequently affected. A distinction must be made here from chancriform (staphylogenic) pyoderma.

Clinical features
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Life-threatening, septic clinical picture with focal edema, central hemorrhagic pustule formation, soft, small-nodular, initially furunculoid elevations . Within hours, torpid decay with formation of large-arched, extensive ulcerations with elevated, hemorrhagic margins.

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Antibiogram and pathogen detection from swabs.

Differential diagnosis
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Furuncle (no septic clinical picture, mostly staphylococci, intial similar course, but no phlegmonous spread).

Chancroid pyoderma: predilection=face; causative agent usually staphylococci;

Botryomycosis: chronic course with sporotrichoid nodules; usually Staphlococcus aureus;

External therapy
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Removal of necrotic and bacteria-containing coatings, wound dressings with polyvidon iodine ointments(e.g. Braunovidon iodine ointment).

Internal therapy
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Resistance to antibiotics is to be expected. Therefore treatment after an antibiotic biogram. In case of severe infections always combination therapy, e.g. with an acylureidopenicillin (e.g. piperacillin). Alternatively, ceftriaxone (e.g. Rocephin) once/day 2 g i.v. Alternatively, ciprofloxacin (Ciprobay) combined with an aminoglycoside such as tobramycin (Gernebcin) Start therapy as soon as possible, in case of suspicion even before the antibiogram.

Operative therapie
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Consistent renovation of entry ports.

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Serious, danger of sepsis.

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  10. Shah M et al (2022) Ecthyma gangrenosum. 2022 May 8. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. PMID: 30521198.
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Last updated on: 14.06.2022