Ecthyma gangrenosum in a patient with metastatic leiomyosarcoma undergoing chemotherapy: a case report

Ecthyma gangrenosum (EG) is a rare necrotizing skin infection most commonly associated with Pseudomonas in immunocompromised patients. Increasingly, EG has been identified in nonbacteremic or immunocompetent patients with various microbial etiologies, expanding its range of clinical presentations.

A 40 year-old patient with metastatic leiomyosarcoma presented two-weeks after initiating chemotherapy with multiple necrotic vulvar lesions with an erythematous rim, characteristic of EG. She had no systemic symptoms. She was treated empirically with ciprofloxacin and wound cultures confirmed Pseudomonas infection. The lesions resolved with antibiotic treatment alone, not requiring surgical intervention.

This represents the second reported case of EG in a patient with gynecologic malignancy. It highlights that EG may present without systemic symptoms, even in high-risk neutropenic patients, and underscores the importance of early detection and antipseudomonal antibiotic initiation to prevent adverse outcomes associated with EG in vulnerable oncologic populations.