Ecthyma gangrenosum - Anogenital in
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 ecthyma gangrenosum from cellulitis on the presence of ulcers and hemorrhagic vesicles and bullae. Be particularly suspicious of this diagnosis in patients that are immunosuppressed.
L08.0 – Pyoderma
17732003 – Ecthyma gangrenosum
- Cellulitis or erysipelas
- Fournier gangrene
- Gas gangrene
- Pyoderma gangrenosum
- Vasculitides such as cryoglobulinemia
- Disseminated intravascular coagulation / purpura fulminans