Description
A 14 year-old-girl, a recently diagnosed case of pre-B acute lymphoblastic leukaemia (on modified BFM-90 protocol, week 2), presented with septic shock (heart rate, 124/min; blood pressure, 70/40 mm Hg) and swelling on the left side of face with necrotic ulcer, local induration and tenderness (figure 1A) of 2 days duration suggestive of ecthyma gangrenosum. Cultures from skin scraping, biopsy and peripheral blood revealed Pseudomonas aeruginosa. Evaluation for mucormycosis (fungal culture and histology of skin/nasal scrapings) was negative. She was promptly treated with empirical antibiotics and antifungals, later tailored per sensitivity (intravenous imipenem, intravenous amikacin). Her situation initially worsened during the first 48 h (figure 1B) but subsequently recovered in 2 weeks (figure 1C, D).
Figure 1
(A) Ecthyma gangrenosum with swelling of the left side of the face with two ulcers of 5x5 mm along the left border of the nose and another measuring 1x2 mm below...
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