Early Identification of Ecthyma Gangrenosum on the Eyelid Margin

Ecthyma gangrenosum is an uncommon cutaneous manifestation of Pseudomonas aeruginosa bacteremia, and even more rarely occurs in the periorbital region. Only a handful of prior case reports discuss lesions on the eyelid, often describing cases with rapid progression of necrosis requiring aggressive debridement. This series describes 2 cases of Pseudomonas-positive ecthyma gangrenosum on the eyelid margin in neutropenic patients, which were identified within 24 hours of lesion onset. Both cases were medically managed with rapid resolution of neutropenia and systemic anti-pseudomonal antibiotics, with no need for surgical debridement.