Ecthyma due to Streptococcus Pyogenes Mimicking Cutaneous Anthrax

Abstract

Ecthyma is a form of ulcerative impetigo which erodes through epidermidis and dermis. Mostly, the crusts are found on the lesions, and when the crust is removed, there is a purulent ulcer at the bottom. Herein, we report a patient who presented with ecthyma lesions on his legs to the outpatient clinic and had cutaneous anthrax reporting for differential diagnosis. A 10-year, 6-month old boy admitted to the hospital with five lesions with some of them are wet yellowish-colored, and some of them crusted in black color, surrounded with the hyperemic area on the leg which did not respond to topical treatment. In physical examination, he had no other pathological sign. The laboratory results showed a white blood cell (WBC) count of 9900/mm3, a hemoglobin level of 13.6 g/dL, platelet count of 478000/mm3 and C-reactive protein of 8.6 mg/L (0–3.5 mg/L. Biochemical values were normal. The patient was consulted the Department Dermatology and ecthyma was the primary diagnosis. However, cutaneous anthrax was in a differential diagnosis. Thus, we sent two swabs, one swab for PCR and one swab for culture. Because of penicillin allergy of the patient, clindamycin and ciprofloxacin were started. Streptococcus pyogenes yielded in culture and tests for anthrax were negative. Thus, we stopped ciprofloxacin and clindamycin therapy continued. On the day of 10th, the patient was discharged because of the crusted lesions with no hyperemic area. S. pyogenes is still susceptible to penicillin; however, it may cause severe complications. Thus, it should be treated promptly.

Keywords

• child
• cutaneous anthrax; etyma.