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Revista Latinoamericana de Infectología Pediátrica

ISSN 2683-1678 (Print)
Órgano Oficial de la Sociedad
Latinoamericana de lnfectología Pediátrica.
Órgano de la Asociación Mexicana de
Infectología Pediátrica, A.C.
Órgano difusor de la Sociedad Española
de lnfectología
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2022, Number 4

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Rev Latin Infect Pediatr 2022; 35 (4)

Gangrenous ecthyma in the periocular region due to multidrug-resistant Pseudomonas aeruginosa

Gómez GLE, Plazola HSI, Ramírez CAM, Peña ACH, Velázquez GN, Martínez BME, Ordóñez OJ
Full text How to cite this article 10.35366/109407

DOI

DOI: 10.35366/109407
URL: https://dx.doi.org/10.35366/109407

Language: Spanish
References: 8
Page: 146-150
PDF size: 244.64 Kb.


Key words:

ecthyma gangrenosum, Pseudomonas aeruginosa, skin lesion, periorbita, eyelids, vacuum assisted aspiration system.

ABSTRACT

Pseudomonas aeruginosa is one of the most important causes of morbidity and mortality in immunocompromised patients, mainly in hospital settings. Ecthyma gangrenosum is a cutaneous manifestation of systemic Pseudomonas infection. Clinical presentacion is as indurated, necrotic, and painless skin lesions. This case report presents a 1-year-old male infant, with a history of biphenotypic leukemia and central nervous system infiltration, who underwent allogeneic stem cell transplantation two times, one month prior to presenting erythema and ulceration in the lower eyelid and left periorbital region; which quickly progression to tissue necrosis. Biopsy-culture and blood culture was performed, microbiological isolation and histopathological reported P. aeruginosa, managed initially with cefepime for AmpC resistance pattern, however fever flare up at 3 weeks, central line-associated bloodstream infection was diagnosed, same bacteria with new enzymatic resistance mechanism was isolated and confirmed by phenotypic test. It was approached in a multidisciplinary way by broad-spectrum systemic antibiotic ceftazidime/avibactam and surgical treatment, to eradicate the focus of infection, ensuring the functionality of the affected site.


REFERENCES

  1. Moradali MF, Ghods S, Rehm BH. Pseudomonas aeruginosa Lifestyle: a paradigm for adaptation, survival, and persistence. Front Cell Infect Microbiol. 2017; 7: 39. Available in: https://doi.org/10.3389/fcimb.2017.00039

  2. Lin Q, Hu B, Shi J, Shi W, Cao W, Li L. Eyelid and periorbital ecthyma gangrenosum due to Pseudomonas aeruginosa in an infant. Pediatr Investig. 2017; 1 (1): 47-49. doi: 10.1002/ped4.12005.

  3. Tuon FF, Dantas LR, Suss PH, Tasca Ribeiro VS. Pathogenesis of the Pseudomonas aeruginosa Biofilm: a review. Pathogens. 2022; 11 (3): 300. Available in: https://doi.org/10.3390/pathogens11030300

  4. Serrano-Martín MM, Del Boz J, Chaffanel-Peláez M, Vera-Casaño A. Facial ecthyma gangrenosum in 2 preterm neonates. Actas Dermosifiliogr. 2012; 103 (7): 637-638. doi: 10.1016/j.ad.2011.07.022

  5. Ibrahim D, Jabbour JF, Kanj SS. Current choices of antibiotic treatment for Pseudomonas aeruginosa infections. Curr Opin Infect Dis. 2020; 33 (6): 464-473. Available in: https://doi.org/10.1097/QCO.0000000000000677

  6. Kunz Coyne AJ, El Ghali A, Holger D, Rebold N, Rybak MJ. Therapeutic strategies for emerging multidrug-resistant Pseudomonas aeruginosa. Infect Dis Ther. 2022; 11 (2): 661-682. Available in: https://doi.org/10.1007/s40121-022-00591-2

  7. Yassaee KM, James DW. Ecthyma Gangrenosum. Medscape. 2021. Available from: https://emedicine.medscape.com/article/1053997-overview

  8. Birlutiu V, Birlutiu RM, Baicu M, Iancu GM. A case report of double etiology of ecthyma gangrenosum: Pseudomonas aeruginosa and Enterococcus faecalis in an immunocompromised child occurred during influenza evolution. Medicine (Baltimore). 2019; 98 (20): e15651. Available in: https://doi.org/10.1097/MD.0000000000015651




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Rev Latin Infect Pediatr. 2022;35