Potentially life-threatening emergency
Ecthyma gangrenosum in Child
See also in: Cellulitis DDx,AnogenitalAlerts and Notices
Synopsis
Risk factors include immunodeficiency syndromes or immunosuppressive therapy, or chronic disease states such as severe burns, malnutrition, and diabetes mellitus. Preceding viral or upper respiratory illnesses with Group A streptococcus have also been reported. Some pediatric patients were discovered on development of EG to have underlying intraabdominal or other internal abscesses. EG is particularly common in the pediatric oncology population, commonly associated with neutropenia, hypogammaglobulinemia, or iatrogenic skin breakdown as a route for initial infection in patients without concurrent bacteremia. Systemic antibiotic treatment has also been reported as a predisposing factor.
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%.
Codes
ICD10CM:L08.0 – Pyoderma
SNOMEDCT:
17732003 – Ecthyma gangrenosum
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Diagnostic Pearls
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Differential Diagnosis & Pitfalls
- Bullous impetigo – Bullae are more flaccid, erosions are more shallow than ulcerative.
- Herpes simplex disseminated – Lesions are more clustered, pustules can be present.
- Pyoderma gangrenosum – Lesions are more tender, patients are less likely to be systemically sick.
- Rickettsialpox – There is a history of preceding bite with more mild systemic malaise, fever, and headaches.
- Necrotizing vasculitis
- Acute meningococcemia – Rash is more petechial, retiform, and purpuric.
- Calciphylaxis – Patient is likely to have history of renal failure, lesions are more retiform and can spread very quickly. Very rare in children.
- Disseminated intravascular coagulation (DIC) – Much more severely ill patient with significant lab abnormalities.
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Therapy
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References
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Last Reviewed:09/14/2017
Last Updated:10/09/2017
Last Updated:10/09/2017
Potentially life-threatening emergency
Ecthyma gangrenosum in Child
See also in: Cellulitis DDx,Anogenital