Ecthyma gangrenosum in a 3-month-old, previously healthy infant

RATIONALE Ecthyma gangrenosum (EG) is an aggressive cutaneous disease caused by local or systemic infection with Pseudomonas aeruginosa. EG is characterized by cutaneous manifestations ranging from nodule and papule, to necrotic ulceration with surrounding erythema, especially with black eschar or central crust. EG presents with characteristic skin lesions which is important to establish diagnosis of sepsis caused by P aeruginosa, a serious condition that can be treated efficiently if diagnosed early. PATIENT CONCERNS A 3-month-old female infant was presented with characteristic skin lesions of EG and developed sepsis 3 days later. DIAGNOSES Ecthyma gangrenosum and sepsis caused by Pseudomonas aeruginosa. INTERVENTIONS Meropenem was used in combination with ceftazidime at first and excision of necrotic skin lesions was performed later. OUTCOMES Cure. LESSONS Early recognition of EG plays an important role in providing appropriate empiric antibiotic treatment at early stage of sepsis, and improves the prognosis. Surgical excision may be helpful if no improvement was achieved via antibiotic treatment.