Ecthyma gangrenosum in a young neutropenic patient with recent Dengue virus infection

Ecthyma gangrenosum (EG) is an uncommon manifestation of Pseudomonas aeruginosa bloodstream infection (BSI), which mostly affects immunocompromised individuals. We describe the case of a 30-year-old woman with hyperthyroidism on methimazole who developed fever, skin and gingival lesions after returning from Nepal, where she experienced insect bites and discontinued methimazole. She presented with severe neutropenia and hemorrhagic and bullous gingival and face skin lesions. Isolation from blood cultures of P. aeruginosa prompted the start of antibiotic therapy with ciprofloxacin, leading to an improvement in clinical conditions, resolution of leukopenia and healing of lesions. Meanwhile, Dengue virus IgM seroconversion was detected. Dengue virus infection may have caused transient immunosuppression, contributing to the development of EG. The lack of worsening neutropenia after reintroducing methimazole further supports Dengue virus infection as the underlying cause. This case underlines the potential role of Dengue virus in causing immunosuppression, predisposing to BSI from P. aeruginosa and EG.