An Infant with Measles Developed Ecthyma Gangrenosum Caused by Coagulase-Negative Staphylococcus: A Rare Case Report from Somalia

Abstract

Introduction and Importance

Ecthyma gangrenosum is a skin lesion that can be caused by either bacterial hematogenous seeding or a primary skin infection. Despite being the most frequent causal agent, Pseudomonas aeruginosa is not the only bacteria that has been involved. Other types of bacteria may also be implicated in the etiology of EG: cocci bacteria, both gram-positive and gram-negative.

Case Presentation

Here, we report the case of a 10-month-old male infant who developed ecthyma gangrenosum after a measles infection. At the time of admission, the patient had a high fever of about 40.3°C and appeared conscious. Physical examination revealed several skin lesions that were in various stages of development and appeared as nodules with a central crust and round, ulcerated, necrotic papules in the face, chest, and upper extremities. Laboratory tests showed CRP of 25 mg/l, LDH of 579 U/L, WBC of 15.06 × 1000/mm3, and absolute neutrophils of 1930/mm3 (12.8%). The result of the culture showed coagulase-negative Staphylococcus. According to the drug susceptibility test results, intravenous Vancomycin (20 mg/kg per dose, 3 times daily) should be started. A coagulase-negative Staphylococcus was eliminated as a result of this defervescence. The necrotic lesion was surgically removed from the patient.

Clinical Discussion

Ecthyma gangrenosum is the all-over-the-body cutaneous manifestation of pseudomonas infection in sepsis patients. Patients who suffer from severe illnesses. Immune deficiencies commonly increase the chance of acquiring EG. Our patient had a history of measles, which led to neutropenia before developing EG. The management of ecthyma gangrenosum requires early identification and antimicrobial treatment.

Conclusion

We describe a measles patient who developed coagulase-negative Staphylococcus ecthyma gangrenosum and had good results from both surgical debridement and systemic antibiotics. Our case serves as an example of the uncommon presentation of ecthyma gangrenosum. This example emphasizes the value of an early diagnosis and vigorous antimicrobial therapy in cases where ecthyma gangrenosum is clinically suspected.

Keywords:

• ecthyma gangrenosum
• coagulase-negative Staphylococcus
• measles

Provenance and Peer Review

Not commissioned, externally peer-reviewed.

Ethical Approval

Case reports are not subject to ethical review at our institution. However, the parent of the child provided us with written authorization before publishing this case report and the associated pictures.

Consent for Publication

Written informed consent was obtained from the parent of the child for publication of this case report and accompanying images. A copy of the written consent is available for review by the Editor-in-Chief of this journal on request.

Author Contributions

Every author contributed significantly to the work reported, whether it was in the design, execution, acquisition of data, analysis, and interpretation, or in all of these areas; they also participated in the article’s drafting, revision, or critical review; they approved the final version that was published; they agreed on the journal to which the article was submitted; and they agreed to take responsibility for every aspect of the work. Guarantor: Ahmed Isse Ali, the corresponding author.

Disclosure

The authors report no conflicts of interest in this work.

Additional information

Funding

There is no funding to report.