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Potentially life-threatening emergency
Ecthyma gangrenosum in Adult
See also in: Cellulitis DDx,Anogenital
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Other Resources UpToDate PubMed
Potentially life-threatening emergency

Ecthyma gangrenosum in Adult

See also in: Cellulitis DDx,Anogenital
Print Images (25)
Contributors: Yun Xue MD, Susan Burgin MD
Other Resources UpToDate PubMed

Synopsis

Ecthyma gangrenosum (EG) is a cutaneous manifestation of gram-negative bacteremia, most commonly secondary to Pseudomonas aeruginosa. It is seen predominantly in immunocompromised patients due to immunodeficiency syndromes or immunosuppressive therapy, or in chronic disease states such as severe burns, malnutrition, and diabetes mellitus. However, characteristic clinical lesions can also develop in immunocompetent individuals without associated sepsis.

Characteristic purpura or black eschars develop in the setting of proliferating microorganisms invading the adventitia and media of blood vessels, causing occlusion and ischemic necrosis. Bacterial organisms include P. aeruginosa, other species of Pseudomonas, Escherichia coli, Klebsiella pneumoniae, Vibrio vulnificus, Serratia marcescens, Aeromonas hydrophila, Morganella morganii, and Moraxella species.

Severe complications such as nephritis and osteomyelitis may occur. The course depends on the underlying disease, but once manifestations of shock appear, the patient may quickly and irreversibly decline. Disseminated intravascular coagulation (DIC) may appear with gram-negative sepsis. Most patients are systemically ill and have associated fever, chills, and hypotension. Diabetic patients, however, may have few symptoms early in the disease. EG is seen in approximately 1.3%-13% of patients with P. aeruginosa sepsis. The mortality rate ranges from 18%-96%.

Differentiate EG from cellulitis based on the presence of ulcers and hemorrhagic vesicles and bullae. Be particularly suspicious of this diagnosis in patients who are immunosuppressed.

Codes

ICD10CM:
L08.0 – Pyoderma

SNOMEDCT:
17732003 – Ecthyma gangrenosum

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Last Reviewed: 09/05/2017
Last Updated: 10/06/2017
Copyright © 2019 VisualDx®. All rights reserved.
Potentially life-threatening emergency
Ecthyma gangrenosum in Adult
See also in: Cellulitis DDx,Anogenital
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Ecthyma gangrenosum : Chills, Fever, Eschar, Painful skin lesions, Skin ulcer, Widespread
Clinical image of Ecthyma gangrenosum
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