Ecthyma Gangrenosum: A Rare Cutaneous Manifestation Caused by Stenotrophomonas maltophilia in a Leukemic Patient

Department of Dermatology, Gachon University of Medicine and Science, Gil Medical Center, Incheon, Korea.
Annals of Dermatology (Impact Factor: 1.39). 11/2009; 21(4):389-92. DOI: 10.5021/ad.2009.21.4.389
Source: PubMed


Ecthyma gangrenosum (EG) is a well-recognized cutaneous infection that most commonly affects immunocompromised patients. It typically occurs on the extremities, or in gluteal and perineal regions. Although Pseudomonas aeruginosa is the most well-known pathogen causing EG, other organisms have been reported to cause EG. Herein we report a rare case of ecthyma gangrenosum presenting as aggressive necrotic skin lesions in perioral and infraorbital areas in a 47-year-old patient with acute myelocytic leukemia after allogeneic bone marrow transplantation. It was caused by Stenotrophomonas maltophilia, which is an aerobic, gram-negative pathogen that has been associated only rarely with cutaneous disease. Blood culture and tissue culture were positive for S. maltophilia. Histological examination revealed numerous tiny bacilli in the dermis and perivascular area. Early recognition of skin lesions caused by S. maltophilia is important to decrease associated mortality in immunosuppressed patients.

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    ABSTRACT: Ecthyma gangrenosum (EG) is a rare cutaneous infection that typically develops in patients with chronic diseases and immunodeficiencies; however, it has been reported rarely in previously healthy children. Although Pseudomonas aeruginosa is the most common pathogen responsible for EG, it was also described in cases of infections by group A streptococcus, Aeromonas hydrophila, Staphylococcus aureus, Citrobacter freundii, and Escherichia coli.We report EG lesions caused by Streptococcus pyogenes in a previously healthy child.
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    ABSTRACT: Aeromonas species are gram-negative anaerobic rods found in fresh water lakes and streams. They have also been recovered from chlorinated tap water, including hospital water supplies. Aeromonas infections of freshwater traumatic wounds cause a characteristic clinical picture indistinguishable from group A streptococcal infection in normal hosts. Rapidly progressive cellulitis develops within 8–48 h after trauma with freshwater exposure, followed by suppuration and necrosis around the wound, often requiring surgical debridement. Fasciitis, myonecrosis, and osteomyelitis may develop. Aeromonas hydrophilia is the species that causes most soft tissue infections and bacteremias. Other species isolated include A. veronii subtype sobria and A. caviae.
    Cutaneous Manifestations of Infection in the Immunocompromised Host, 01/2012: pages 245-279; , ISBN: 978-1-4419-1577-1
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    ABSTRACT: Stenotrophomonas maltophilia is a recently described organism which was mainly reported either in nosocomial setup, or in immunosuppresed individuals. This was rarely reported as cutaneous pathogenic organism causing cellulitis-like lesion, paronychia, mucocutaneous ulcers and ecthyma gangrenosum in immunocompromised individuals. Here we describe a case of leg ulcer caused by S. maltophilia in an immuno-competent patient. The infection was possibly community acquired as the patient had no exposure to hospital environment. The bacillus was sensitive to cotrimoxazole and levofloxacin, and the patient was successfully treated with cotrimoxazole. Our case is unique not only because it is probably the first ever case of leg ulcer caused by S. maltophilia, but also because of its unusual occurrence in immunocompetent patient.
    International Wound Journal 01/2012; 10(3). DOI:10.1111/j.1742-481X.2012.00938.x · 2.15 Impact Factor
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