Potentially life-threatening emergency
Ecthyma gangrenosum - Anogenital in
See also in: Overview,Cellulitis DDxAlerts and Notices
Synopsis
Characteristic purpura or eschars develop when proliferating microorganisms invade 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, Citrobacter freundii, Stenotrophomonas maltophilia, Morganella morganii, and Moraxella species.
Severe complications such as osteomyelitis may occur from infection with P aeruginosa. 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%-13% of patients with P aeruginosa sepsis. The mortality rate ranges from 18%-96%.
Codes
ICD10CM:L08.0 – Pyoderma
SNOMEDCT:
17732003 – Ecthyma gangrenosum
Look For
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Diagnostic Pearls
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Differential Diagnosis & Pitfalls
- Cellulitis or erysipelas
- Fournier gangrene
- Gas gangrene
- Pyoderma gangrenosum
- Vasculitides such as cryoglobulinemia
- DIC / purpura fulminans
- Calciphylaxis
- Complex aphthosis
- Candidemia
- Mucormycosis
- Aspergillosis
- Fusarium infection
Best Tests
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Management Pearls
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Therapy
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References
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Last Reviewed:08/03/2021
Last Updated:08/05/2021
Last Updated:08/05/2021
Potentially life-threatening emergency
Ecthyma gangrenosum - Anogenital in
See also in: Overview,Cellulitis DDx