Ecthyma gangrenosum in a newborn causing external otitis with complete facial nerve palsy

Ecthyma gangrenosum (EG) involving the external ear canal is an unusual presentation.

To describe a case of EG diagnosed in a 5-day-old female who was admitted to our institute with multiple soft-tissue lesions involving the right arm, forearm, back, and perineum and with a complete facial palsy associated with ipsilateral external otitis.

The patient presented neonatal sepsis associated with significant leucopenia, thrombocytopenia and alteration of the coagulation profile. Microbiological analysis was performed on the purulent otorrhea and on the exudate material collected at the level of the genital lesion; both of these specimens tested positive for the presence of Pseudomonas aeruginosa. An intravenous antibiotic treatment was administered and a rapid improvement from the infection was observed.

The rare occurrence of this presentation, combined with the potential for fatal complications from EG if not swiftly diagnosed underline the importance of this case.