2025 Volume 62 Issue 1 Pages 84-89
Ecthyma gangrenosum (EG) is an uncommon cutaneous infection characterized by an initial painful erythema with vesicles and pustules that progresses to central necrotic ulcers. EG is often associated with Pseudomonas aeruginosa bacteremia in immunocompromised patients. Here, we report two cases of pseudomonal EG that developed during chemotherapy-induced neutropenia in patients with acute lymphoblastic leukemia. Case 1 involved a nine-year-old girl who presented with EG on her right arm after consolidation therapy. She was treated with tazobactam-piperacillin, and the lesion improved within two weeks following neutrophil recovery. Case 2 involved a 12-year-old girl who developed EG in her left thigh during induction therapy. She was treated with cefepime; however, EG progressed to deep ulcers and granulomatous lesions, which required local debridement. Complete healing was not achieved after five months because antileukemic chemotherapy was administered concurrently. Thus, EG should be considered in febrile patients who develop painful erythema, induration, and blistering during chemotherapy-induced neutropenia.
