ECTHYMA GANGRENOSUM IN CHILDREN WITH CANCER: DIAGNOSIS AT A GLANCE. A
retrospective study form the Infection Working Group of Italian
Pediatric Hematology Oncology Association.
Abstract
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.