Ecthyma gangrenosum in a preterm infant.

Dear Editors, Ecthyma gangrenosum (EG) is a rare infection that is characteristically seen in immunocompromised patients and presents as embolic lesions caused by Pseudomonas aeruginosa (1). This type of infection has distinct pathognomonic features along with a high mortality rate, but when recognised early, it can be successfully treated. The classic lesions associated with EG are composed of deep ulcers with ecchymotic, gangrenous centres, bright red areolae and typical raised, purplish, indurated and rolled-out edges (1,2). An infant born at the 28th gestational week with a birthweight of 1200 g was admitted to the neonatal intensive care unit of our facility because of a large teratoma in the sacrococcygeal region on the first postnatal day. A complete resection was performed on the third postnatal day, and the pathology results showed a grade three immature teratoma. Chemotherapy (cisplatin, bleomycin and etoposide) was started on the 24th postnatal day and continued for four cycles at 3-week intervals. When the patient reached the 60th postnatal day, which coincided with the end of the second course of chemotherapy, ulcerated lesions were found over the infant’s entire body (Figure 1). Blood andwound cultures were performed, and the results identified the presence of P. aeruginosa. Based on the antibiotic susceptibility of this bacterium, meropenem treatment was started, and a complete recovery was observed after 21 days of treatment. To date, very few cases of EG have been reported during the neonatal period (1–5). However, preterm infants are especially at risk because of their immature immune system (3). The chemotherapy treatment in conjunction with the infant’s prematurity facilitated the development of EG in our