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Hemorrhagic Vesiculobullous Lesions of Ecthyma Gangrenosum in a Diabetic Patient with Myelofibrosis: A Rare Presentation of Septic Shock without Pseudomonas aeruginosa Bacteremia

Patient: Male, 52-year-old Final Diagnosis: Ecthyma gangrenosum Symptoms: Vesiculobollous eruption Clinical Procedure: — Specialty: Critical Care Medicine • Dermatology • Infectious Diseases OBJECTIVE: Unusual clinical course BACKGROUND: Ecthyma gangrenosum is a rare skin lesion associated with Pseu...

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Autores principales: Muqarrab, Fatimah Jawad Al, Al Mosbeh, Mohammed J., Haddad, Taher Ali Al, Al Muhainy, Nora A.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: International Scientific Literature, Inc. 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10402291/
https://www.ncbi.nlm.nih.gov/pubmed/37518986
http://dx.doi.org/10.12659/AJCR.939905
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author Muqarrab, Fatimah Jawad Al
Al Mosbeh, Mohammed J.
Haddad, Taher Ali Al
Al Muhainy, Nora A.
author_facet Muqarrab, Fatimah Jawad Al
Al Mosbeh, Mohammed J.
Haddad, Taher Ali Al
Al Muhainy, Nora A.
author_sort Muqarrab, Fatimah Jawad Al
collection PubMed
description Patient: Male, 52-year-old Final Diagnosis: Ecthyma gangrenosum Symptoms: Vesiculobollous eruption Clinical Procedure: — Specialty: Critical Care Medicine • Dermatology • Infectious Diseases OBJECTIVE: Unusual clinical course BACKGROUND: Ecthyma gangrenosum is a rare skin lesion associated with Pseudomonas aeruginosa, an aerobic gram-negative opportunistic bacterial pathogen. In non-bacteremia patients, sepsis is not a common complication. Immunocompromised patients are more commonly affected. If diagnosis and therapy are delayed, the mortality rate is 18–96%. This report is of a 52-year-old man with diabetes mellitus and myelofibrosis presenting with hemorrhagic vesiculobullous lesions of ecthyma gangrenosum on the upper and lower extremities, oral mucosa, and anogenital area with, interestingly, no associated Pseudomonas aeruginosa bacteremia. CASE REPORT: A 52-year-old diabetes patient with myelofibrosis presented with hemorrhagic vesiculobullous and necrotic eschar-covered erosions over the upper and lower extremities, oral mucosa, and anogenital area. Although he appeared septic looking initially, with signs of end-stage organ failure, and he was later determined to have septic shock, the clinical diagnosis was not possible without a positive culture swab of the cutaneous lesions showing growth of Pseudomonas aeruginosa. The diagnosis of cutaneous ecthyma gangrenosum-induced septic shock was confirmed, though bacteremia was not detected. This patient was successfully managed with the early initiation of proper antibiotics. CONCLUSIONS: Early detection and vigilance when confronted with the clinical presentation of ecthyma gangrenosum are a vital part of patient management to reduce the high mortality risk of the disease. Although bacteremia is associated with a high risk for fatalities, cutaneous ecthyma gangrenosum can be complicated by septic shock and serious adverse events. The involvement of multidisciplinary teams in patient management is an essential aspect of ecthyma gangrenosum disease management.
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spelling pubmed-104022912023-08-05 Hemorrhagic Vesiculobullous Lesions of Ecthyma Gangrenosum in a Diabetic Patient with Myelofibrosis: A Rare Presentation of Septic Shock without Pseudomonas aeruginosa Bacteremia Muqarrab, Fatimah Jawad Al Al Mosbeh, Mohammed J. Haddad, Taher Ali Al Al Muhainy, Nora A. Am J Case Rep Articles Patient: Male, 52-year-old Final Diagnosis: Ecthyma gangrenosum Symptoms: Vesiculobollous eruption Clinical Procedure: — Specialty: Critical Care Medicine • Dermatology • Infectious Diseases OBJECTIVE: Unusual clinical course BACKGROUND: Ecthyma gangrenosum is a rare skin lesion associated with Pseudomonas aeruginosa, an aerobic gram-negative opportunistic bacterial pathogen. In non-bacteremia patients, sepsis is not a common complication. Immunocompromised patients are more commonly affected. If diagnosis and therapy are delayed, the mortality rate is 18–96%. This report is of a 52-year-old man with diabetes mellitus and myelofibrosis presenting with hemorrhagic vesiculobullous lesions of ecthyma gangrenosum on the upper and lower extremities, oral mucosa, and anogenital area with, interestingly, no associated Pseudomonas aeruginosa bacteremia. CASE REPORT: A 52-year-old diabetes patient with myelofibrosis presented with hemorrhagic vesiculobullous and necrotic eschar-covered erosions over the upper and lower extremities, oral mucosa, and anogenital area. Although he appeared septic looking initially, with signs of end-stage organ failure, and he was later determined to have septic shock, the clinical diagnosis was not possible without a positive culture swab of the cutaneous lesions showing growth of Pseudomonas aeruginosa. The diagnosis of cutaneous ecthyma gangrenosum-induced septic shock was confirmed, though bacteremia was not detected. This patient was successfully managed with the early initiation of proper antibiotics. CONCLUSIONS: Early detection and vigilance when confronted with the clinical presentation of ecthyma gangrenosum are a vital part of patient management to reduce the high mortality risk of the disease. Although bacteremia is associated with a high risk for fatalities, cutaneous ecthyma gangrenosum can be complicated by septic shock and serious adverse events. The involvement of multidisciplinary teams in patient management is an essential aspect of ecthyma gangrenosum disease management. International Scientific Literature, Inc. 2023-07-31 /pmc/articles/PMC10402291/ /pubmed/37518986 http://dx.doi.org/10.12659/AJCR.939905 Text en © Am J Case Rep, 2023 https://creativecommons.org/licenses/by-nc-nd/4.0/This work is licensed under Creative Common Attribution-NonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0 (https://creativecommons.org/licenses/by-nc-nd/4.0/) )
spellingShingle Articles
Muqarrab, Fatimah Jawad Al
Al Mosbeh, Mohammed J.
Haddad, Taher Ali Al
Al Muhainy, Nora A.
Hemorrhagic Vesiculobullous Lesions of Ecthyma Gangrenosum in a Diabetic Patient with Myelofibrosis: A Rare Presentation of Septic Shock without Pseudomonas aeruginosa Bacteremia
title Hemorrhagic Vesiculobullous Lesions of Ecthyma Gangrenosum in a Diabetic Patient with Myelofibrosis: A Rare Presentation of Septic Shock without Pseudomonas aeruginosa Bacteremia
title_full Hemorrhagic Vesiculobullous Lesions of Ecthyma Gangrenosum in a Diabetic Patient with Myelofibrosis: A Rare Presentation of Septic Shock without Pseudomonas aeruginosa Bacteremia
title_fullStr Hemorrhagic Vesiculobullous Lesions of Ecthyma Gangrenosum in a Diabetic Patient with Myelofibrosis: A Rare Presentation of Septic Shock without Pseudomonas aeruginosa Bacteremia
title_full_unstemmed Hemorrhagic Vesiculobullous Lesions of Ecthyma Gangrenosum in a Diabetic Patient with Myelofibrosis: A Rare Presentation of Septic Shock without Pseudomonas aeruginosa Bacteremia
title_short Hemorrhagic Vesiculobullous Lesions of Ecthyma Gangrenosum in a Diabetic Patient with Myelofibrosis: A Rare Presentation of Septic Shock without Pseudomonas aeruginosa Bacteremia
title_sort hemorrhagic vesiculobullous lesions of ecthyma gangrenosum in a diabetic patient with myelofibrosis: a rare presentation of septic shock without pseudomonas aeruginosa bacteremia
topic Articles
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10402291/
https://www.ncbi.nlm.nih.gov/pubmed/37518986
http://dx.doi.org/10.12659/AJCR.939905
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