Untitled - Ecthyma Gangrenosum - Demo (CDr)
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Ecthyma Gangrenosum in Immunocompromised Patient without Detectab. Search Enter search terms:. Unfortunately, trauma to the area only makes the disorder worse due to a phenomenon called pathergy, or the exacerbation of a skin injury after trauma. As a result, the surgeon and patient are working in circles because the disorder is not being properly treated.
In postoperative pyoderma gangrenosum, the PG ulcerations are often mistaken for an infection at the surgery site.
This commonly happens after breast surgeries, and the result may be devastating. A similar presentation happens after other types of surgeries, such as splenectomy for myelodysplastic syndrome and stoma placement with ulcerative colitis or Crohn disease. The surgeon usually reacts by debriding the tissue Untitled - Ecthyma Gangrenosum - Demo (CDr) administering antibiotics to prevent more ulceration.
While antibiotics may help PG as an adjunctive medication, the debridement irritates the ulcer and exacerbates its progression. Most patients may see several physicians until the disorder is correctly diagnosed.
We are still learning much about the causes of Untitled - Ecthyma Gangrenosum - Demo (CDr) gangrenosum and its systemic associations. Postoperative PG seems to occur most often in breast tissue after tumor removal but also after augmentations. Orthopedic, cardiothoracic, abdominal, and other surgeries may also initiate PG at the sites of incision.
Ecthyma gangrenosum might be the first manifestation of an underlying medical problem and previously healthy patients should be followed closely in the future [ 710 ]. The lesion begins as a painless red macule that enlarges and becomes a slightly elevated papule.
It evolves to a hemorrhagic bulla that ruptures, forming a gangrenous ulcer with a gray-black eschar surrounded by an erythematous halo [ 1 ]. Classically, the pathogen is isolated from the skin lesions as well as from the blood. These lesions may occur anywhere, but are most usual on the anogenital region, buttocks, extremities, abdomen, axillae and rarely on the face [ 15 Untitled - Ecthyma Gangrenosum - Demo (CDr).
Histologically, the lesions represent a necrotising Untitled - Ecthyma Gangrenosum - Demo (CDr) caused by direct bacterial invasion of the media and adventitia of the vascular walls, but not the intima [ 2 ].
In general, acute mixed inflammatory cell infiltration and vascular proliferation are seen in the dermis, often involving the subcutaneous tissue. Elastases produced by Pseudomonas destroy the elastic small vessels, leading to hemorrhage and release of organisms into the surrounding tissue.
Protease and endotoxin A elaborated by bacilli are responsible for the direct tissue destruction and ulcerative lesions. In classic bacteremic ecthyma gangrenosum, the lesion represents a blood-borne metastatic seeding of Pseudomonas aeruginosa to the skin. However, there are a few reports that ecthyma gangrenosum can represent localized skin eruptions that are not accompanied by bacteremia or systemic infection [ 1 — 6 ].
The source of infection in this patient cannot be determined with certainty, but it is possible that the patient presented with erysipelas which subsequently became colonized and superinfected with hospital-acquired Pseudomonas aeruginosa while draining and then developed into ecthyma gangrenosum.
Negative blood cultures suggest that ecthyma gangrenosum occurred as a primary lesion at a site of prior skin trauma. Early diagnosis and aggressive therapy are important in the management of ecthyma gangrenosum. An antipseudomonal beta-lactam antibiotic with Untitled - Ecthyma Gangrenosum - Demo (CDr) without an aminoglycoside is appropriate for treatment of both bacteremic and nonbacteremic ecthyma gangrenosum [ 5 ].
The absence of bacteremia is associated with the best outcome. In another study, the mortality rate was 7.
As we point out in this case, ecthyma gangrenosum may develop even in the absence of bacteremia and even in immunocompetent people. It may be treated with appropriate antibiotics upon diagnosis by tissue culture and microscopic examination. In conclusion, ecthyma gangrenosum should be considered as a possible diagnosis even when a previously healthy patient has negative blood cultures. Written informed consent was obtained from the patient for publication of this case report and any accompanying images.
A copy of the written consent is available for review by the Editor-in-Chief of this journal. Report of six cases and review of the literature.
Arch Intern Med. Am J Med. Acta Derm Venereol. Rev Clin Esp. Clin Exp Dermatol.
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