Gram-negative bacillary cellulitis in patients with hepatic cirrhosis

Eight episodes of gram-negative bacillary cellulitis in seven patients with hepatic cirrhosis are reported. The patients comprised five women and two men (mean age 59.6 years). The diagnosis was based on a positive culture of specimens obtained by needle aspiration from cutaneous lesions. All patients had grade C cirrhosis according to Pugh's classification. Cellulitis involved the lower extremities in all cases. Five patients developed bullous lesions, three ulcers, two abscesses and two extensive cutaneous necrosis. A single bacterial species was found in seven cases. Organisms isolated were Klebsiella pneumoniae (3 cases), Escherichia coli (2 cases), Pseudomonas aeruginosa (2 cases), Proteus mirabilis (1 case) and Aeromonas hydrophila (1 case). Bacteremia was documented in six cases. Four patients died, death being related to sepsis in three of them. It is concluded that gram-negative bacilli should be considered as possible pathogens in severe infectious cellulitis in patients with advanced cirrhosis. Microbiological study of cutaneous specimens obtained by needle aspiration may be of high diagnostic value in these cases.