Ecthyma Gangrenosum and Associated Pseudomonas Aeruginosa Infections

Ecthyma gangrenosum is a rare but life-threatening cutaneous manifestation most often associated with Pseudomonas aeruginosa bacteraemia in immunocompromised patients. Lesions typically begin as erythematous macules that rapidly evolve into necrotic ulcers with a central black eschar and erythematous halo, reflecting perivascular bacterial invasion and vessel wall destruction. Neutropaenia, haematological malignancy, burn injury and prolonged intensive-care stays represent major risk factors. In some cases, lesions may arise without demonstrable bloodstream infection, necessitating tissue culture and histopathology for definitive diagnosis. Rapid recognition and empirical antipseudomonal therapy are critical to reduce morbidity and mortality, which can exceed 40 per cent in high-risk groups. Advances in understanding the molecular mechanisms of P. aeruginosa virulence—such as exotoxin A production and elastase-mediated vessel wall damage—have informed novel therapeutic strategies. Emergence of multidrug-resistant strains underscores the importance of antimicrobial stewardship and the development of adjunctive therapies, including immunomodulatory agents. Globally, ecthyma gangrenosum serves as a sentinel marker of severe sepsis and underlying immunodeficiency, emphasising the need for interdisciplinary approaches integrating dermatology, infectious diseases and critical care.

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Ecthyma Gangrenosum and Associated Pseudomonas Aeruginosa Infections publication trend

The graph below shows the total number of articles in ecthyma gangrenosum and associated pseudomonas aeruginosa infections across all publications each year (not limited to Nature Index journals).

Technical terms

Ecthyma gangrenosum: A necrotising cutaneous lesion characterised by perivascular invasion of pathogens, most commonly Pseudomonas aeruginosa, leading to ulceration with a central eschar.

Pseudomonas aeruginosa: An opportunistic Gram-negative rod notable for biofilm formation, multidrug resistance and production of exotoxins that facilitate vascular destruction.

Neutropaenia: A reduction in circulating neutrophils below normal thresholds, significantly impairing host defence against bacterial and fungal infections.

Bacteraemia: The presence of viable bacteria in the bloodstream, which can seed distant organs and precipitate severe systemic inflammatory responses.

Immunocompromised host: An individual with impaired immune function due to congenital conditions, malignancy, immunosuppressive therapies or chronic disease.

Vasculitis: Inflammation and necrosis of the blood vessel wall, often leading to ischaemia, haemorrhage and tissue infarction in affected areas.

References

1. Ecthyma gangrenosum: a report of eight cases*. Anais Brasileiros de Dermatologia (2017).
2. Ecthyma gangrenosum without bacteremia in a previously healthy man: a case report. Journal of Medical Case Reports (2008).
3. Acute myeloid leukaemia presenting with ecthyma gangrenosum as the first manifestation. Medicine (2021).