Clinicopathologic aspects of ecthyma gangrenosum in burn patients: A retrospective study

Maria Jenica So, MD1, Ma. Adela Nable-Aguilera, MD, FPAPRAS 2, 3

1 Philippine Association of Plastic, Reconstructive and Aesthetic Surgery, 711 A. Soriano Hi-way, Amaya, Tanza, Cavite, Philippines, 4108,
2 Philippine Association of Plastic, Reconstructive and Aesthetic Surgery, Plastic Surgery Office, Philippine General Hospital, Taft Ave., Ertmita, Manila, Philippines, 1000,

Background: Ecthyma gangrenosum (EG) is a characteristic lesion described as small indurated black spots on the skin, which is usually associated with Pseudomonas aeruginosa septicemia in immunocompromised hosts, burn patients being among the populations at risk. It is a pathology which is not uncommon in the PGH-ATR Burn Center.  It is noted for its high morbidity and mortality and therefore its diagnosis requires a high index of suspicion.  Early detection through identification of patient risk factors is thus essential in the management of EG.

Objective: To identify factors associated with an increased risk of developing EG among burn patients.

Methods: This is a retrospective analytical study of patients who developed EG during their admission at the PGH ATR Burn Center from January 1, 2010 to December 31, 2014, compared with those who did not develop EG, focusing on the possible risk factors that may predispose patients to developing EG.  A binary stepwise logistic regression was performed with a final regression model accounting for 66% of the variation in incidence (p = < .001).

Results: Twenty one out of the 753 burn cases reviewed developed EG. The incidence density rate is noted at 2.20%, with a case fatality rate of at least 61.9%.  The odds of diabetes mellitus was approximately 194 timed as great among those who developed EG.  Patients with bigger burn size (20-40% and >40% TBSA) have increased risk versus those with burn size below 10% TBSA were also increased.  Tulle dressings also increased the risk of developing EG.  Age, mechanism of injury, burn depth, concomitant infection, and prior burn surgery were not associated with increased risk for EG (p>0.05). Fever, hypotension, dyspnea and change in sensorium are the common clinical signs associated with EG patients.  Methicillin resistant Staphylococcus aureus was the most frequently found blood isolate, while Pseudomonas aeruginosa was found to be the most common isolate in tissue cultures.

Conclusion: Among burn patients admitted at the PGH ATR Burn Center, diabetes mellitus, burn size greater than 20% of total body surface area and the use of tulle dressings are significant risk factors in developing EG.

Key Words

Ecthyma gangrenosum, Burn Infection, Pseudomonas septicemia

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