Ecthyma on the forehead: rare condition in the community setting.

A 19-year-old previously healthy Japanese man presented with septic shock and forehead ulcer. Three months earlier, he was treated with antibiotic and analgesics for fever and sore throat. Two days before, he noticed a small acne-like lesion on his forehead. This grew rapidly and thus he visited our department. On admission, he was in septic shock. His neck was stiff, with a small abscess on the right side. He had a forehead ulcer with a black, necrotic center without tenderness. His leukocyte count was very low (200/mm) with 8% neutrophils. Blood cultures, skin biopsy, aspirate of neck abscess, and spinal fluid all grew Pseudomonas aeruginosa. The diagnosis of ecthyma gangrenosum with Pseudomonas sepsis, meningitis and neck abscess was made. He responded to antibiotics and the leukocyte count spontaneously recovered. Immunological studies including HIV test were all negative. Ecthyma gangrenosum is a rare condition associated with neutropenia and Pseudomonas sepsis. It is generally seen in hospital settings, and very rarely found in the community (1, 2). In this case, neutropenia probably occured secondary to medications.