Abstract

Ecthyma gangrenosum (EG) is a cutaneous infection characterized by vesicles or blisters which rapidly evolve into necrotic ulcers with undermined tender erythematous border. It has been rarely reported from the African continent. Pseudomonas aeruginosa is the commonest isolated organism but others, including Staphylococcus aureus (S. aureus) and Escherichia coli ((E. coli) have been reported. A case of EG in a child with S. aureus meningitis in whom E. coli was also isolated is hereby reported. An 8-month old male infant presented with fever (39.2°C) of two days, vomiting, diarrhoea, and body rashes (purpuric lesions mainly on the gluteal area as well as the lower and upper limbs) of one day, and convulsions. He was moderately dehydrated, with neck stiffness and retraction. The rashes subsequently became extensive, appearing as circumscribed, roundish and dark necrotic lesions with surrounding hyperaemia. Full blood count showed marked leucocytosis with neutrophilia. Blood glucose was 6.1 mmol/l, cerebrospinal fluid (CSF) glucose was 3.6 mmol/l and protein was 55 mg/dl, CSF culture yielded S. aureus. Culture of skin lesions was initially negative but later yielded E. coli on repeat sampling. The patient was treated with antibiotics, wound debridement and regular dressings and showed good improvement, evidenced by the gradual healing of skin lesions. EG lesions may be caused by other organisms apart from Pseudomonas.

Key words: Ecthyma gangrenosum, infant, Staphylococcus aureus, Escherichia coli, meningitis, Sokoto.