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Images/Instrument in dermatology/Dermatosurgery
2021
:1;
16
doi:
10.25259/CSDM_13_2021

Ecthyma gangrenosum in a healthy male

Departments of Dermatology and STD, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
Departments of Pathology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
Corresponding author: Arunachalam Narayanan, Department of Dermatology and STD, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India. narayanan359@gmail.com
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This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-Share Alike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.

How to cite this article: Narayanan A, Kumari R, Toi PC, Thappa DM. Ecthyma gangrenosum in a healthy male. CosmoDerma 2021;1:16.

A 45-year-old male patient presented with multiple, well-defined, circular, black-brown necrotic eschar with an erythematous halo over the bilateral shin area [Figure 1a-c], thighs, and scrotum. The lesions started as erythematous macules, which progressed into bullae and later evolved to result in necrotic eschar over the next 15 days. Histopathological examination of leg lesion revealed epidermal necrosis and ulceration with acute inflammatory infiltrate, fibrinous exudate, and bacterial colonies [Figure 2a and b]. The inflammation extended into the dermis and subcutis with associated vasculitis [Figure 2c and d]. Bacterial culture of tissue from necrotic eschar revealed Escherichia coli and Enterococcus faecalis. Based on these reports, a diagnosis of ecthyma gangrenosum was made, and the patient was treated with intravenous piperacillin-tazobactam for 14 days with good improvement. Although, ecthyma gangrenosum is classically described as a systemic Pseudomonas aeruginosa infection in immunocompromised patients; it has also been reported in healthy patients. The causative agents include Streptococcus,Staphylococcus, and Escherichia coli. Lesions are seen over the lower extremities, anogenital area, and buttocks. Early diagnosis and appropriate antibiotic therapy are essential for treatment.

Figure 1:: (a-c) Multiple, well-defined, circular, black-brown necrotic eschar with an erythematous halo over the bilateral shin area.
Figure 2:: (a) Section shows skin with necrosis and ulceration of the epidermis, acute inflammatory exudate, fibrin, bacterial colonies, and inflammation reaching the subcutis (hematoxylin and eosin stain, ×40). (b) Section shows skin with ulceration (black arrow), fibrin, and acute inflammatory (red arrow) exudate (hematoxylin and eosin stain, ×100). (c) Section shows vasculitis (red arrow) (hematoxylin and eosin stain, ×200). (d) Section shows acute inflammatory infiltrate in the subcutaneous fat along with vasculitis (hematoxylin and eosin stain, ×200).

Declaration of patient consent

Patient’s consent not required as patients identity is not disclosed or compromised.

Financial support and sponsorship

Nil.

Conflicts of interest

Devinder Mohan Thappa is the Editor-In-Chief of the journal.


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