Purpose. To describe ecthyma gangrenosum (EG) characteristics and complications in a large multicenter pediatric retrospective collection of children with malignancies or bone marrow failure syndromes. Methods. EG episodes diagnosed in the period 2009-2019 were identified by a retrospective review of clinical charts at centers belonging to the Italian Pediatric Hematology Oncology Association. Results. EG occurred in 38 children (male/female 16/22; median age 5.2 years) with hematological malignancy (33), allogeneic stem cell transplantation (2) or relapsed/refractory solid tumor (3). The involved sites were: perineal region (19), limbs (10), trunk (6), head and the iliac crest (3). Bacteremia was present in 22 patients. Overall, the germs isolated were Pseudomonas aeruginosa (34), Stenotrophomonas maltophilia (3) and Escherichia Coli (1); 31% of them were MDR. All patients received antibacterial treatment while surgery was performed in 24 patients (63.1%). Predisposing underlying conditions for EG were: severe neutropenia (97.3%), corticosteroid treatment (71%), iatrogenic diabetes (23.7%). All patients recovered, but EG recurred in 5 patients. Nine patients (24%) showed sequelae (deep scars, with muscle atrophy in 2). Four patients (10.5%) died, 1 due to relapse of EG with KPC co-infection, 3 due to the underlying disease. Conclusions. EG requires early recognition and a proper and timely treatment to obtain the recovery and to avoid larger necrotic evolution. The occurrence of scarring sequelae might affect the quality of life of patients.

Febrile neutropenia and lung infections are common and potential fatal complications of pediatric cancer patients during chemotherapy. Lung ultrasound (LUS) has a good accurancy in the diagnosis of pneumonia in childhood. To our knowledge there are no studies concerning its utilization in the diagnosis and follow-up of pulmonary infection in children with cancer. The goal of this pilot study is to determine the accuracy of lung ultrasonography for the diagnosis and follow up of pneumonia in children and adolescents with cancer during fever. This is a prospective observational case-control monocentric study conducted in the Pediatric Hematology and Oncology Department of University Hospital of Catania in patients aged<18 years with cancer, with or without fever. Attending Physician used ultrasonography to diagnose pneumonia in children with cancer during fever. Non infected cancer patients were also tested with LUS to evaluate its accuracy. When performed, the results of chest X-ray and chest CT scan were compared with LUS results. Thirty-eight patients were studied. All underwent LUS, 16 underwent CXR, 3 chest CT. Statistical analysis showed LUS specificity of 95%, and sensitivity of 100%; CXR, instead showed a specificity of 80% and a sensitivity of 50%. The positive predictive value of LUS was 90% while that of CXR was 50%. The negative predictive value of LUS was 100% while that of CXR was 80%.This study shows for the first time that LUS allows physicians to diagnose pneumonia in children and young adults with cancer, with high specificity and sensitivity.

Carbapenemase-producing Enterobacteriaceae (CPE) , multidrug resistant (MDR) threatens children undergoing chemotherapy. A previous survey reported increase of bloodstream infections and colonization in a 2 year-observation time. To test the efficacy of the measures put in place , a second survey was performed. Data were collected from 13 Italian pediatric cancer centers of AIEOP network. The colonization rate per 1000 hospitalizations days was 0.5 (0.37-0.65) not different from the 0.48 rate (0.36-0.63) observed previously .Yet the 0.12 rate of bacteriemia (0.07-0.21) compared favorably with the 0.42 (0.31-0.57) observed. The awareness of colonization status allowed reducing CPE related morbidity and mortality.