Ecthyma gangrenosum in Saudi Arabia

We report a diagnosis of ecthyma gangrenosum (EG) in 4 females of mean age 54.8 (range 43-64) years, within 10 months. Severe drug reaction treated with high dose systemic corticosteroids in patient 1, acute myelocytic leukemia treated with high dose dexamethasone and multiple broad-spectrum antibiotics in patient 2precede the onset of EG. Patients 3 and 4 had vasculitic purpura and hemodialysis. In addition, patient 3 was receiving multiple broad-spectrum antibiotics plus anti-tuberculosis (TB) drugs for gastric TB, while patient 4 was on melphalan and high dose systemic corticosteroids. Pseudomonas aeruginosa was isolated from blood culture of the first 3 patients and skin culture of patient one. Blister aspirate from patient 4 yielded Candida albicans. Factors enhancing skin invasion by pathogenic organisms in our patients were breached skin integrity, therapy with high dose corticosteroids and multiple broad-spectrum antibiotics, hematologic malignancies and chemotherapy with severe neutropenia. (author)