1. Ecthyma gangrenosum in pediatrics
JUAN ROJAS (1)
JUAN LOPEZ (2)
YULY MUÑOZ (2)
GUILLERMO GONZALEZ (3)
Pediatric Infectious Diseases Fellowship Program. University El Bosque/ University Libre sectional Cali. Colombia, South America.
Physician. University Libre sectional Cali, Colombia, South America.
Pediatric dermatologist. Club Noel Children´s Hospital. University Libre sectional Cali, Colombia, South America. r

2. Introduction
Etiology
Clinical Manifestations
Histologic findings
Differential diagnosis
Treatment

3. Introduction Ecthyma gangrenosum (EG) is a rare infection of the skin
Lesion caused by P. aeruginosa
Other types of bacteria: S. aureus or beta hemolytic group
Often associated:
Primary and secondary immunodeficiency
Qualitative and quantitative neutrophil defects
Infectio 2013;17(1):43–47
Acta Pædiatrica 2015; 104:134–138

4. Introduction
Mortality: 40%-75% of immunologically compromised individuals
Characterized by black eschars on an erythematous base
Diagnosis:
Symptoms
Cultures and skin biopsies
Infectio 2013;17(1):43–47
Acta Pædiatrica 2015; 104:134–138

5. Pediatric Dermatology 2013; 30 (6): 1-2
Etiology
The most common pathogen: P. aeruginosa
A. hydrophila, S. aureus, S. marcescens, E. coli, K. pneumoniae, N. meningitidis, V. vulnificus, B. cepacia
Fungi: Fusarium sp, Candida sp, Mucor and Aspergillus sp
caused by P. aeruginosa, but can also be caused by a number of pathogens such as Aeromonas hydrophila, Staphylococcus aureus, Serratia marcescens, Escherichia coli, Klebsiella pneumoniae, Neisseria meningitidis, Vibrio vulnificus, Burkholderia cepacia; and fungi such as Fusarium sp, Candida sp, Mucor and Aspergillus sp
Acta Pædiatrica 2015; 104:134–138
Pediatric Dermatology 2013; 30 (6): 1-2

6. Clinical Manifestations
Hemorrhagic bullae or necrotic ulcers that have progressed from painless macules or papules
Often the presenting lesion will exhibit an erythematous halo
Depending on the extent of infection and immune status:
The patient may also be febrile with other constitutional symptoms
Dermatology Online Journal 2012; 18 (3): 3

7. Treatment: acyclovir, clindamycin and cefepime
Clinical case
Girl: 5 years old
Initially presented chickenpox and then infection with S. aureus EG
Treatment: acyclovir, clindamycin and cefepime
A, B, C, D: Erosions and deep ulcers, with serous and hematic crusts, necrotic background
Infectio 2013;17(1):43–47

8. A, B, C: erythematous papules and macules with irregular borders
Infectio 2013;17(1):43–47

9. Exudating deep, blackish eschar surrounded by extended
ulceration and erythema
Arch Dis Child 2015;100:54–56

10. Necrotic skin lesion with surrounding erythema and dilated veins
Arch Dis Child Fetal Neonatal 2011; 96 (4): 1

11. Erythema, nodules, bulla, and ulcers with necrosis
on the right femoribus internus
Pediatric Dermatology 2011; 28 (2): 1-3

12. Initial presentation Wound at 2 months
Pediatric Dermatology 2013; 30 (6): 1-2

13. Dermatology Online Journal 2012; 18 (3): 3
Histologic findings
Necrotizing vasculitis in which the media and adventitia of the vascular wall are invaded, but the intima is spared
Singapore Med J. 2006; 47: 1080
Dermatology Online Journal 2012; 18 (3): 3
Infectio 2013;17(1):43–47

14. Differential diagnosis
Bacterial cellulitis
Insect bites
In the early, hyperaemic phase
Deep group α β-haemolytic Streptococci impetigo
Burns
In the late, eschar-necrotising phase
Arch Dis Child 2015;100:54–56

15. Pediatric Dermatology 2011; 28 (2): 1-3
Treatment
Empirical antimicrobial therapy:
Anti-Pseudomonal penicillins
and aminoglycosides
Adjusted on the basis of culture results
Should be started
Pediatric Dermatology 2011; 28 (2): 1-3
Arch Dis Child 2015;100:54–56
Acta Pædiatrica 2015; 104:134–138

16. Pediatric Dermatology 2011; 28 (2): 1-3
Treatment
Debridement
Assessment of immune function
Full blood count and peripheral blood smear
HIV serology
Immunoglobulin levels
Neutrophil function tests
Pediatric Dermatology 2011; 28 (2): 1-3
Arch Dis Child 2015;100:54–56
Acta Pædiatrica 2015; 104:134–138