Ecthyma Gangrenosum in a Child with Severe Burns

Ecthyma gangrenosum (EG) is a rare, necrotising manifestation of cutaneous or systemic infection, most often associated with Pseudomonas aeruginosa. Other causative organisms include: Staphylococcus aureus, Aeromonas hydrophila, and fungi including Candida and Aspergillus species. EG can present as indurated, violaceous, or black lesions and can rapidly progress to frank tissue necrosis. Typically, this condition occurs in immunocompromised patients, such as those with malignancy or severe burns. Early diagnosis is imperative, and management requires to be aggressive, with initiation of high-dose, broad-spectrum antibiotics, providing Pseudomonal cover and urgent surgical debridement. Despite optimal medical and surgical management, mortality rates remain high.

We present a case of Pseudomonas associated EG with photographs in a 17-month old girl with 56% total body surface area (TBSA) partial-thickness scald burns and propose a management algorithm based on review of the literature.

Keywords: Invasive, pseudomonas, ecthyma, gangrenosum, burns, infection, paediatric.