Elsevier

Urology

Volume 80, Issue 6, December 2012, Pages 1366-1368
Urology

Pediatric Case Report
Labial Ecthyma Gangrenosum in an Immunocompromised Infant With Leukemia: Heightening Awareness for the Urologist

https://doi.org/10.1016/j.urology.2012.08.020Get rights and content

Ecthyma gangrenosum (EG) is a cutaneous infection most commonly associated with Pseudomonas aeruginosa sepsis. EG generally occurs in immunocompromised hosts, such as patients with severe neutropenia. EG presents as erythematous, hemorrhagic, or necrotic macules or plaques, most commonly in the perineal or gluteal areas, but can occur elsewhere. EG is a dermatologic emergency in immunocompromised patients and should be included in the differential diagnosis when urologists are asked to evaluate perineal lesions. We describe the case of a highly immunocompromised infant with labial EG to highlight the importance of prompt clinical diagnosis and of multidisciplinary medical and surgical management.

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Case Report

An 11-month-old girl with high-risk infant B-precursor acute lymphoblastic leukemia (ALL) in the consolidation phase of chemotherapy was admitted to the Children's Hospital of Philadelphia with fever and chemotherapy-associated neutropenia. She had been severely neutropenic, with an absolute neutrophil count (ANC) of <200 cells/μL, for at least 7 days before admission. Her parents had also noted mild right labial erythema, swelling, and discomfort with diaper changes for 3 days before

Comment

EG is a rare cutaneous lesion classically associated with P. aeruginosa sepsis that occurs most frequently in severely immunocompromised patients.1, 2, 3 It is characterized by erythematous, hemorrhagic, or necrotic macules or plaques, most commonly of the perineal or gluteal skin, that can rapidly progress into a gangrenous ulcer or eschar.1 Although most commonly caused by P. aeruginosa, EG has also been associated with other bacteria, including Aeromonas hydrophila, Staphylococcus aureus,

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Gregory E. Tasian and Sarah K. Tasian contributed equally to this work.

Financial Disclosure: The authors declare that they have no relevant financial interests.

Funding Support: Dr. Gregory Tasian is supported by National Institutes of Health (NIH)-5T32HD060550-03. Dr. Sarah Tasian is supported by NIH-K12CA076931.

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