Ecthyma amidst the global monkeypox outbreak: A key differential? -A case series

Area of Science:

• Dermatology
• Infectious Diseases

Background:

• Ecthyma is a deep form of impetigo affecting the epidermis and dermis, presenting as ulcerative plaques.
• Commonly caused by group A beta-hemolytic streptococcus and Staphylococcus aureus, ecthyma often affects children.
• Its early skin lesions can resemble other vesicular and ulcerative dermatoses, including those seen in mpox.

Observation:

• Three cases illustrate diverse ecthyma presentations mimicking mpox.
• A 12-year-old male with atopic dermatitis initially suspected of mpox was diagnosed with ecthyma via biopsy.
• An 18-year-old male presented with rapidly progressing ulcerated lesions and systemic symptoms, confirmed as ecthyma.
• A 55-year-old woman with rapidly developing hand lesions also received an ecthyma diagnosis.

Findings:

• Histopathological findings and cultures confirmed ecthyma in all presented cases.
• Differential diagnoses considered included mpox, toxic shock syndrome, and necrotizing fasciitis.
• Empirical antibiotic therapy was effective in resolving lesions in one case.

Implications:

• Misdiagnosis and delayed treatment of ecthyma can lead to severe outcomes.
• Given its potential severity and current mpox vigilance, ecthyma should be considered in the differential diagnosis of ulcerative skin lesions.
• Healthcare providers must be aware of ecthyma's varied presentations to ensure accurate and timely patient management.