CASE REPORT article
Front. Pediatr.
Sec. Pediatric Infectious Diseases
This article is part of the Research TopicNew Discoveries and Challenges in Pediatric Infectious Diseases: Epidemiological, Clinical, and Pathogenic AdvancesView all 10 articles
Community-acquired Pseudomonas aeruginosa sepsis presenting with ecthyma gangrenosum in a neutropenic infant: a case report
Provisionally accepted
- 1Shanghai Children's Hospital, Shanghai, China
- 2Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Background: Ecthyma gangrenosum (EG) is a distinctive cutaneous marker of Pseudomonas aeruginosa (P. aeruginosa) bacteremia, particularly in neutropenic hosts. In infants, community-acquired P. aeruginosa infection can precipitate fulminant septic shock with high mortality, underscoring the importance of early EG recognition. Case presentation: We report a 4-month-old ex-preterm girl presenting with fever, lethargy, and feeding intolerance. Investigations revealed profound neutropenia (ANC 0.08×10⁹/L), markedly elevated inflammatory markers, and a violaceous perianal plaque. Within 24 hours, the lesion progressed to necrotic ulceration with septic shock. Blood and wound cultures confirmed P. aeruginosa. Management included meropenem therapy, continuous renal replacement for cytokine storm, intravenous immunoglobulin, and urgent surgical debridement, resulting in clinical stabilization and wound improvement. Conclusions: EG is an early sentinel sign of community-acquired P. aeruginosa bacteremia in neutropenic infants. Careful perianal and genital examination is essential in febrile neutropenia, and prompt initiation of anti-pseudomonal therapy with timely source control is critical to reduce mortality.
Keywords: Neutropenia, Ecthyma gangrenosum, Pseudomonas aeruginosa, Community-acquired infection, Pediatric sepsis
Received: 19 Sep 2025; Accepted: 12 Nov 2025.
Copyright: © 2025 Wang, Xiao, Ge, Zhang and Li. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Xiaolu Li, lixl1@shchildren.com.cn
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