July 1993

Picture of the Month

Author Affiliations

From the Children's Medical Center of Brooklyn (NY), Kings County Hospital Center, University Hospital of Brooklyn (Drs Secord, Mills, and Shah).

Am J Dis Child. 1993;147(7):795-796. doi:10.1001/archpedi.1993.02160310097029

A 7-month-old infant with a 7-day history of fever developed a progressive perianal rash (Figs 1 through 3). The lesions began as erythematous macules that developed vesicles. The vesicles subsequently coalesced to form bullae. Ulcerated lesions developed after rupture of the bullae. The lesions shown are covered with an eschar and surrounded by a raised, erythematous halo.

The infant was severely malnourished, with weight, height, and head circumference below the fifth percentile for age. She was anemic (hemoglobin, 51 g/L) and hypoalbuminemic (albumin, 14 g/L). Figures 4 and 5 show the lesions after 7 and 21 days of therapy, respectively.

Denouement and Discussion 

Ecthyma Gangrenosum Secondary to Pseudomonas aeruginosa 

Manifestations  Cutaneous infections secondary to Pseudomonas aeurginosa have various appearances. In healthy hosts, the infections include otitis externa, severe toe-web infections, hot tub folliculitis, green nail syndrome, and various forms of superficial pyoderma, including vesiclelike and verrucouslike lesions. In chronically ill

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