SHM Converge Scientific Abstract ePoster Gallery-An Atypical Case of Ecthyma Gangrenosum

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This case report describes an atypical presentation of ecthyma gangrenosum (EG), a necrotic skin infection classically associated with <em>Pseudomonas aeruginosa</em> and immunocompromised patients. EG usually presents as erythematous nodules that rapidly progress to necrotic ulcers with eschar, often on the gluteal, perineal, or extremity areas. Although most cases are linked to <em>Pseudomonas</em>, other organisms—including <em>E. coli</em>—can also cause EG.

The patient was a 43-year-old man with atrial fibrillation on warfarin, chronic kidney disease, and systolic heart failure who presented with diarrhea, dyspnea, shock, and atrial fibrillation with rapid ventricular response. He required ICU care, vasopressors, cardioversion, intubation, and continuous renal replacement therapy. He was started empirically on cefepime and vancomycin. Blood cultures grew <em>E. coli</em> and enterobacterales, and a gastrointestinal source was suspected but not confirmed.

During hospitalization, erythema of the left lower extremity initially thought to be cellulitis progressed into bullae, retiform purpura, and worsening ulcers over one week. Dermatology and Infectious Disease were consulted. Skin biopsy and tissue cultures grew <em>E. coli</em>, and pathology confirmed EG. Despite broad-spectrum antibiotics, clearance of bacteremia, and a normal immune workup, the lesions worsened and ultimately required two surgical debridements and wound vacuum placement, with later plans for skin grafting.

This case highlights that EG can occur in immunocompetent patients and may be caused by <em>E. coli</em> rather than <em>Pseudomonas</em>. It also emphasizes the diagnostic challenge of distinguishing EG from DIC or septic vasculitis in critically ill patients. While antibiotics are the mainstay of treatment, surgical debridement and grafting may be necessary when lesions fail to improve.

Asset Subtitle

Neha Bhoomreddy

Meta Tag

Author List Emily Fortman, Neha Bhoomreddy, Teja Mallela

Category Clinical Vignettes

Concept Ecthyma Gangrenosum

Concept Pseudomonas aeruginosa

Concept Broad-Spectrum Antibiotic

Concept Skin Lesion Morphology

Concept Pathogen

Distinguished Non-Finalist

Presenter Organization OSU Wexner Medical Center, Division of Hospital Medicine

Presenting Author Neha Bhoomreddy

Track Adult

Keywords

ecthyma gangrenosum

E. coli

Pseudomonas aeruginosa

necrotic skin infection

immunocompetent patient

retiform purpura

bullae

septic vasculitis

surgical debridement

skin biopsy

Ecthyma Gangrenosum

Pseudomonas aeruginosa

Broad-Spectrum Antibiotic

Skin Lesion Morphology

Pathogen