Ecthyma gangrenosum in a neonate- A case report
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Ecthyma gangrenosum (EG) is a well-known cutaneous manifestation of severe, invasive infection by Pseudomonas aeruginosa. The characteristic lesions of EG are hemorrhagic pustules that evolve into necrotic punched-out gangrenous ulcers with black–gray eschar. It is usually seen in immunocompromised and critically ill patients. However, there are isolated reports of its occurrence in normal healthy individuals. This case reports the development of EG in a normal neonate.

A 4-day-old term male neonate presented with the complaints of multiple skin lesions that began on the 2nd postnatal day, associated with fever and decreased oral acceptance since the 3rd day of life. Initially, red macules developed over the inguinal and perineal region with subsequent ulceration over the next 3–4 days. Similar lesions developed on the abdomen, face, and left eyelid.

The skin lesions were associated with continuous low-grade fever and lethargy. There was a history of redness around the umbilicus without any discharge.

On examination, the baby was of term gestational age, weighing 2480 g. The baby was lethargic, hyperthemic, tachypneic, and not accepting feeds. Bilateral inguinal region showed multiple, well-defined, punched-out gangrenous ulcers with raised erythematous borders and central black eschar. The largest lesion was seen at the left groin measuring 3 cm × 2 cm, erythematous and necrotic with central eschar. Similar lesions were present over the abdomen and face. Induration was present around the umbilicus.

Neonate blood culture grew P. aeruginosa. However, culture and Gram staining of discharge from skin lesions did not grow any organism. Urine culture was sterile. Based on the history suggestive of sepsis, typical skin lesions, and blood culture growing P. aeruginosa, the diagnosis of EG associated with Pseudomonas infection was made.

On admission the child was started empirically on cefotaxime and amikacin. Based on pus culture report, antibiotics were upgraded to meropenem and vancomycin. Wound dressings were done daily along with the application of local antibiotics (mupirocin) and silver sulfadiazine. Fresh frozen plasma and platelet transfusion was given. During the course of treatment, fever subsided, the lesions started healing, and no new lesions were seen.