Ecthyma gangrenosum versus ecthyma-like lesions: should we separate these conditions?

Introduction: We analyzed cases of ecthyma gangrenosum (EG) and "ecthyma-like" or "ecthyma-mimicking" cases of necrotic lesions of the skin to improve current definitions of these conditions.

Methods: The retrospective analysis compared 28 cases of lesions (from 2001 to June 2015) that were identified as EG. Age, sex, lesion location, time from macule to ulcer, underlying diseases, number of lesions per patient, wound bacterial culture, blood culture, and immune status served as variables for analysis and comparison.

Results: Only in 20 cases (71.42%) was Pseudomonas aeruginosa the etiology of the lesion. The etiology of eight cases was various bacterial species (five cases, 17.85%) and fungal species (three cases, 10.73%). In 21 cases (75%), the lesion appeared in immunocompromised patients. In four cases (14.28%), the patients suffered from Pseudomonas sepsis. In four cases (14.28%), the lesion appeared in healthy individuals. There was no difference in clinical picture, lesion location, number of lesions per person, and treatment strategy between Pseudomonas and non-Pseudomonas cases.

Conclusion: Necrotic lesions resembling EG can have various microbiological etiology and can occur in immunocompetent or healthy persons. With no difference in clinical picture, two separate definitions should not be applied to Pseudomonas and non-Pseudomonas cases. We suggest accepting a broader definition of EG.