Ecthyma Gangrenosum and Pyelonephritis in an Older Patient with Controlled Diabetes but without HIV or Malignancy

Ecthyma gangrenosum is a rare dermatological manifestation often linked to Pseudomonas aeruginosa bacteremia, typically occurring in immunocompromised individuals. We present a case of ecthyma gangrenosum in a 69-year-old male with diabetes mellitus, but without HIV, malignancy, or chronic immunosuppressive therapy. The patient exhibited septic shock, pyelonephritis, and pneumonia, and was eventually diagnosed with ecthyma gangrenosum due to systemic Pseudomonas aeruginosa infection. This case highlights the occurrence of ecthyma gangrenosum in an older patient with metabolic comorbidities and age-related immune dysfunction, but without classic immunosuppressive conditions. It underscores the importance of early recognition and intervention in such populations, and the need for a nuanced approach to immune status in elderly patients with diabetes.