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• W2144150870 abstract "A healthy 2-year-old female presented with a round, non-tender skin lesion on her buttock, its center black and ulcerated, its margins red. It began as a small black spot a week before and subsequently enlarged and ulcerated, without blister formation, reaching the size and shape shown in the Figure. The patient was afebrile, without systemic signs or symptoms. Her blood tests, including complete blood count (peripheral leukocyte count of 10.3 × 109/L with 3 × 109/L neutrophils, 6.1 × 109/L lymphocytes, 0.9 × 109/L monocytes, and 0.3 × 109/L eosinophils), C-reactive protein, and erythrocyte sedimentation rate were unremarkable. The child had no history of recent viral illness or prolonged water exposure (eg, whirlpool, pool with protracted wet diaper, bath tub, or bath sponge). She came in contact with horses and chickens at her grandfather's farm. Cutaneous anthrax was suggested. A skin-punch biopsy was taken from the lesion and demonstrated fibrin and mixed inflammatory cells with a necrotic area and neutrophils in the connective tissue. The culture revealed Pseudomonas aeruginosa. These findings are consistent with a diagnosis of Ecthyma gangrenosum. Ecthyma gangrenosum is a cutaneous manifestation of severe, invasive infection by Pseudomonas aeruginosa, usually seen in immunocompromised and critically ill patients.1Mina Yassaee SBE, Ravi Ubriani, William D James. Ecthyma gangrenosum. In: Elston DM, ed. Medscape. Available at: http://emedicine.medscape.com/article/1053997-overview. Accessed November 13, 2012.Google Scholar Very few cases have been seen in healthy children presenting with this lesion.2Athappan G. Unnikrishnan A. Chandraprakasam S. Ecthyma gangrenosum: presentation in a normal neonate.Dermatol Online J. 2008; 14: 17PubMed Google Scholar, 3Meislich D. Long S.S. Invasive Pseudomonas infection in two healthy children following prolonged bathing.Am J Dis Child. 1993; 147: 18-20PubMed Google Scholar One review of Ecthyma gangrenosum cases in previously healthy children found that most either had previously undetected immunodeficiencies or transient risk factors (including viral infections and antimicrobial treatment) predisposing them to the development of such infection.4Zomorrodi A. Wald E.R. Ecthyma gangrenosum: considerations in a previously healthy child.Pediatr Infect Dis J. 2002; 21: 1161-1164Crossref PubMed Scopus (88) Google Scholar, 5Martin-Ancel A. Borque C. del Castillo F. Pseudomonas sepsis in children without previous medical problems.Pediatr Infect Dis J. 1993; 12: 258-260Crossref PubMed Scopus (26) Google Scholar, 6Chusid M.J. Hillmann S.M. Community-acquired Pseudomonas sepsis in previously healthy infants.Pediatr Infect Dis J. 1987; 6: 681-684Crossref PubMed Scopus (46) Google Scholar Pseudomonas skin infection are also known to occur in individuals after use of hot-tubs, whirlpools, water slides, and swimming pools. A previous report of two healthy children with invasive Pseudomonas infection linked their infection to prolonged bathing.3Meislich D. Long S.S. Invasive Pseudomonas infection in two healthy children following prolonged bathing.Am J Dis Child. 1993; 147: 18-20PubMed Google Scholar Current literature recommends prompt treatment with systemic antibiotic therapy, with Pseudomonas coverage, once Ecthyma gangrenosum is suspected, based on clinical appearance.4Zomorrodi A. Wald E.R. Ecthyma gangrenosum: considerations in a previously healthy child.Pediatr Infect Dis J. 2002; 21: 1161-1164Crossref PubMed Scopus (88) Google Scholar If the lesion fails to respond to antimicrobials, surgical debridement may be required.7Craigie R.J. Ahmed S. Mullassery D. Panarese A. Caswell M. Kenny S.E. A spot that can kill.Lancet. 2007; 369: 1540Abstract Full Text Full Text PDF PubMed Scopus (3) Google Scholar, 8Khalil B.A. Baillie C.T. Kenny S.E. Lamont G.L. Turnock R.R. Pizer B.L. et al.Surgical strategies in the management of Ecthyma gangrenosum in pediatric oncology patients.Pediatr Surg Int. 2008; 24: 793-797Crossref PubMed Scopus (32) Google Scholar Isolated Ecthyma gangrenosum has an estimated mortality of up to 25%—a rate that is greatly increased by concomitant sepsis.7Craigie R.J. Ahmed S. Mullassery D. Panarese A. Caswell M. Kenny S.E. A spot that can kill.Lancet. 2007; 369: 1540Abstract Full Text Full Text PDF PubMed Scopus (3) Google Scholar In our case, spontaneous recovery was observed prior to the pathologic and microbiologic diagnosis, and the lesion completely resolved within 3 weeks without treatment. Two years since presentation, our patient has encountered no immunologic or other health problems." @default.
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• W2144150870 date "2013-10-01" @default.
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• W2144150870 title "A Healthy 2-Year-Old Child with a Round Black Skin Lesion" @default.
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• W2144150870 doi "https://doi.org/10.1016/j.jpeds.2013.04.038" @default.
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