Non Pseudomonal Ecthyma Gangrenosum in an Immunocompetent Preterm Neonate: A Case Report

Ecthyma gangrenosum (EG) is a rare but severe cutaneous infection, often caused by Gram-negative organisms. It may indicate sepsis or underlying immunodeficiency, although cases in immunocompetent preterm infants are uncommon. We report the case of a preterm male neonate born at 34 + 5 weeks of gestation from a twin pregnancy, weighing 2030 g. He was initially treated for presumed early-onset neonatal bacterial infection with cefotaxime and gentamicin, showing good initial improvement. On Day 7 of life, erythematous plaques appeared in the right inguinal region and on the scrotum, rapidly progressing to necrotic ulcerations. Laboratory findings showed thrombocytopenia with negative C-reactive protein. Ultrasound revealed scrotal and thigh infiltration without abscess or thrombosis. Skin cultures grew Klebsiella pneumoniae and Enterococcus faecium, and blood cultures isolated Enterococcus faecium. Targeted antimicrobial therapy combined with daily wound care led to complete healing with minor residual scarring. Immunologic evaluation was normal. EG can occur in preterm neonates without immunodeficiency, and early microbiological diagnosis with targeted therapy leads to favorable outcomes.