Ecthyma gangrenosum in children with cancer requires early detection, treatment

In children with cancer, early diagnosis and proper and timely treatment of ecthyma gangrenosum (EG) are necessary to achieve recovery and to prevent larger necrotic lesions, which eventually evolve in scarring sequelae, suggests a study.

The authors sought to depict EG clinical presentation and evolution in a large multicentre paediatric retrospective collection of children with malignancies or bone marrow failure syndromes to facilitate early recognition. They conducted a retrospective review of clinical charts at centres belonging to the Italian Pediatric Hematology Oncology Association to identify EG episodes diagnosed from 2009 to 2019.

Thirty-eight EG cases occurred in children (median age 5.2 years, 22 females) with haematologic malignancy, allogeneic stem cell transplantation, or relapsed/refractory solid tumour. Sites involved were the perineal region (n=19), limbs (n=10), trunk (n=6), head, and the iliac crest (n=3). Twenty-two patients had bacteraemia.

The germs isolated were as follows: Pseudomonas aeruginosa (n=30), Stenotrophomonas maltophilia (n=3), and Escherichia coli (n=1). Of these, 31 percent were resistant to multiple drugs.

Antibacterial treatment was given to all patients, while surgery was undertaken in 24 (63.1 percent). Neutropaenia (97.3 percent) was the most common predisposing underlying condition for EG, followed by corticosteroid treatment (71 percent) and iatrogenic diabetes (23.7 percent).

All patients recovered, but five had EG recurrence. Nine patients (24 percent) developed sequelae (deep scars with muscle atrophy in two), while four (10.5 percent) died—one due to relapse of EG with carbapenem-resistant Enterobacteriaceae co-infection and three due to the progression of the underlying disease.