A Healthy Infant With an Ulcerated Genital Lesion: Diagnostic and Therapeutic Considerations
1From the Division of General Pediatrics, The Children's Hospital of Philadelphia, and Department of Pediatrics, Grand View Hospital, Sellersville, PA.
Insights
A penile lesion in a child led to the diagnosis of ecthyma gangrenosum and autoimmune neutropenia. Early wound culturing and immunodeficiency evaluation are crucial for prompt treatment.
Area of Science:
- Pediatric Infectious Diseases
- Dermatology
- Immunology
Background:
- Ecthyma gangrenosum is a rare, potentially life-threatening skin infection.
- It is often associated with Pseudomonas aeruginosa bacteremia.
- Early recognition and treatment are critical.
Observation:
- A 1-year-old boy developed a penile lesion while on antibiotics for otitis media.
- The lesion rapidly ulcerated.
- Wound cultures identified Pseudomonas aeruginosa.
Findings:
- The patient was diagnosed with ecthyma gangrenosum.
- Progressive neutropenia was observed.
- An immunodeficiency evaluation revealed autoimmune neutropenia of childhood.
Implications:
- This case highlights the importance of wound culturing in pediatric infections.
- Clinicians should recognize ecthyma gangrenosum's features and initiate prompt antipseudomonal therapy.
- Evaluating for immunodeficiency is essential, even in seemingly healthy children.
Abstract:
We present the case of a 1-year-old healthy boy who was taking oral antibiotics for an otitis media and then developed an erythematous penile lesion that rapidly became ulcerated. He was admitted to the hospital for further diagnostic studies and intravenous therapy, and his wound culture grew Pseudomonas aeruginosa, consistent with the diagnosis of ecthyma gangrenosum. Serial blood counts also demonstrated a progressive neutropenia, and an immunodeficiency evaluation resulted in the diagnosis of autoimmune neutropenia of childhood. This case illustrates the importance of culturing wounds and the need for clinicians to recognize the characteristic features of ecthyma gangrenosum, to initiate appropriate antipseudomonal antibiotic therapy empirically, and to evaluate for a possible immunodeficiency, even in the apparently healthy child.
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