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Clinical Problem Solving: Pathology
Dec 2012

Pathology Quiz Case 2: Diagnosis

Arch Otolaryngol Head Neck Surg. 2012;138(12):1196. doi:10.1001/archotol.138.12.1196

Ecthyma gangrenosum is a rare necrotizing, opportunistic, pseudomonal infection that is typically found on cutaneous surfaces in immunocompromised patients. This clinical entity is most commonly associated with younger age, neutropenia, pseudomonal bacteremia, immunosuppression, and coexisting hematologic malignancy. Most lesions will occur in the gluteal and perineal region or extremities; however, head and neck involvement may occur in up to 6% of cases.1 Moreover, mucosal involvement is exceedingly rare, with 1 previous reported case of EG affecting the sinonasal tract in a patient with acute lymphocytic leukemia.2 In addition to the sinonasal mucosa, our patient presented with a discrete ulcerative lesion of the epiglottis, which, to our knowledge, is the first reported case of EG demonstrating laryngopharyngeal involvement.