To the Editor.
—I read with interest the article "Ecthyma Gangrenosum Without Bacteremia: Report of Six Cases and Review of the Literature" by Huminer et al1 in the February issue of the Archives and agree totally with their "assumption that ecthyma ganarenosum can be a localized skin lesion not accompanied by bacteremia." In fact, in 1984 we reported two similar cases in the Archives of Dermatology with the title "Necrotic Cullulitis: A Localized Form of Septic Vasculitis."2 We chose this name, instead of ecthyma gangrenosum, because of the connotation of Pseudomonas septicemia and because a variety of organisms (bacterial or fungal) may cause similar-appearing lesions and identical histopathologic changes. These cutaneous ulcers are the result of a localized septic, bacterial, or fungal vasculitis where neutrophils,dust, and fibrin thrombi, common denominators in septic vasculitivasculitis, the superficial and deep blood vessels of the skin (Figs 1and 2). These changes are
Hurwitz RM. Ecthyma Gangrenosum Without Bacteremia or Necrotic Cellulitis:d Form of Septic Vasculitis. Arch Intern Med. 1987;147(8):1513. doi:10.1001/archinte.1987.00370080151030