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

Abstract

Ahmed Isse Ali,1 Abdullahi Ali Mohamed,2 Ibrahim Mohamed Hirsi,2 Mohamed Nur Ali2 1Department of Dermatology, Mogadishu-Somali Turkey Training and Research Hospital, Mogadishu, Somalia; 2Department of Pediatric, Mogadishu-Somali Turkey Training and Research Hospital, Mogadishu, SomaliaCorrespondence: Ahmed Isse Ali, Email [email protected] 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

Keywords

• ecthyma gangrenosum
• coagulase-negative staphylococcus
• measles