—We Hurwitz and his colleagues for their comments strengthening our assumption that ecthyma gangrenosum may be a localized skin lesion not accompanied by bacteremia. However, we think that "necrotic cellulitis" described by Hurwitz and his colleagues is not synonymous with ecthyma gangrenosum but, rather, with a similar cutaneous manifestation of Pseudomonas septicemia, ie, gangrenous cellulitis. Thsi is a sharply demarcate cellulitis that rapidly enlarges to become a necrotic lesion1 and does not evolve through several typical stages, as does ecthyma gangrenosum. The description and figures of the skin lesion in patinet 1 of Hurwitz and his colleagues fit gangrenous or necrotic cellulitis and not ecthyma gangrenosum. Patient 2 in their article had bacteremia. Nevertheless, it appears that both necrotic cellulitis and ecthyma gangrenosum may develop in patients who do not have bacteremia.
Huminer D, Pitlik SD. Ecthyma Gangrenosum Without Bacteremia or Necrotic Cellulitis:d Form of Septic Vasculitis-Reply. Arch Intern Med. 1987;147(8):1513. doi:10.1001/archinte.1987.00370080151031