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Purple Papules and Fever: Ecthyma Gangrenosum. (Immunocompromised Host).

ASPEN, COLO. -- Consider ecthyma gangrenosum in immunocompromised patients who present with purple skin lesions plus fever.

The disease, caused by pseudomonal infection, usually occurs in patients with an immune deficit. Ecthyma gangrenosum can vary in presentation from painless maculopapular lesions to hemorrhagic papules or macules.

These lesions, that are often seen in the axillae and anogenital area, sometimes degenerate into painless necrotic ulcers, Dr. Marsha Anderson said at a conference on pediatric infectious diseases sponsored by Children's Hospital, Denver.

Most patients with ecthyma gangrenosum are bacteremic, but there have been reports of inoculation with pseudomonas breakthrough in the skin, said Dr. Anderson, a pediatric infectious diseases specialist at the University of Colorado, Denver

The differential diagnosis for these patients who present with these sign sincludes crush injury in resolution, pyoderma gangrenosum (think of this if there is associated inflammatory bowel disease and ulceration), and cutaneous anthrax (think of this if there is history of animal exposure). Dr. Anderson said at the conference, which was also sponsored by the university.

Diagnosis of ecthyma gangrenosum can be made by aspirate or biopsy an culture, she noted.

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Author:Worcester, Sharon
Publication:Pediatric News
Geographic Code:1USA
Date:Nov 1, 2001
Words:184
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