An Eschar-like souvenir from a journey to Colombia: Ecthyma gangrenosum as a differential diagnosis of tropical diseases in immunocompromised patients - a case report.

Publisher: BioMed Central Country of Publication: England NLM ID: 100968551 Publication Model: Electronic Cited Medium: Internet ISSN: 1471-2334 (Electronic) Linking ISSN: 14712334 NLM ISO Abbreviation: BMC Infect Dis Subsets: MEDLINE

Original Publication: London : BioMed Central, [2001-

Ecthyma/*diagnosis ; Skin Ulcer/*diagnosis; Adenine/analogs & derivatives ; Adenine/therapeutic use ; Administration, Intravenous ; Aged ; Anti-Bacterial Agents/therapeutic use ; Bronchoalveolar Lavage Fluid/microbiology ; Colombia ; Diagnosis, Differential ; Ecthyma/drug therapy ; Ecthyma/microbiology ; Ecthyma/surgery ; Humans ; Immunocompromised Host ; Immunoglobulins/therapeutic use ; Leukemia, Lymphocytic, Chronic, B-Cell/drug therapy ; Leukemia, Lymphocytic, Chronic, B-Cell/pathology ; Male ; Piperidines/therapeutic use ; Pseudomonas aeruginosa/isolation & purification ; Skin Ulcer/microbiology ; Skin Ulcer/surgery

Background: Ecthyma gangrenosum (EG) is a cutaneous infectious disease characterized by eschar-like skin ulcers typically caused by Pseudomonas aeruginosa. Here, we report a case of relapsing EG in a patient who had returned from a trip to Colombia, thus establishing EG as an important differential diagnosis of tropical diseases, and demonstrating that even long-term antibiotic treatment can result in only partial remission of EG.
Case Presentation: A 77-year-old man with underlying chronic lymphocytic leukemia (CLL) on ibrutinib treatment was admitted because of a superinfected mosquito bite on the left ear and multiple partially necrotic skin lesions disseminated all over the entire body five days after returning from a trip to Colombia. The initial clinical suspicion of a tropical disease (leishmaniosis, systemic mycosis, or others) could not be confirmed. During the diagnostic workup, microbiological cultures of the skin biopsies and bronchoalveolar lavage revealed Pseudomonas aeruginosa, leading to a diagnosis of EG. Initial antibiotic treatment resulted in partial remission. However, the patient had to be re-admitted due to a relapse 3-4 weeks after the first episode. Finally, the patient was successfully treated with a combined approach consisting of antibiotics, recurrent surgical incisions, and administration of immunoglobulins.
Conclusions: In conclusion, EG should be considered as a differential diagnosis in immunosuppressed patients presenting with eschar-like skin ulcers. A combined treatment approach seems to be the best choice to achieve clinical cure and avoid relapse.

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Keywords: Case report; Ecthyma gangrenosum; Ibrutinib; Leukemia; Pseudomonas aeruginosa; Skin ulcer; Tropical disease

0 (Anti-Bacterial Agents)
0 (Immunoglobulins)
0 (Piperidines)
1X70OSD4VX (ibrutinib)
JAC85A2161 (Adenine)

Date Created: 20210413 Date Completed: 20210430 Latest Revision: 20210430

20240105

PMC8042936

10.1186/s12879-021-05998-9

33845789