Case Study

Ecthyma gangrenosum on the face of a malnourished child with Pseudomonas sepsis: Simulating Cancrum oris

Khadijat O. Isezuo, Usman M. Sani, Usman M. Waziri, Bilkisu I. Garba, Yahaya Mohammed, Joy F. Legbo, Nazish P. Aquil, Fatima I. Abubakar, Memuna Omar
African Journal of Laboratory Medicine | Vol 7, No 1 | a756 | DOI: https://doi.org/10.4102/ajlm.v7i1.756 | © 2018 Khadijat O. Isezuo, Usman M. Sani, Usman M. Waziri, Bilkisu I. Garba, Yahaya Mohammed, Joy F. Legbo, Nazish P. Aquil, Fatima I. Abubakar, Memuna Omar | This work is licensed under CC Attribution 4.0
Submitted: 12 January 2018 | Published: 05 December 2018

About the author(s)

Khadijat O. Isezuo, Department of Paediatrics, Usmanu Danfodiyo University Teaching Hospital, Sokoto, Nigeria
Usman M. Sani, Department of Paediatrics, Usmanu Danfodiyo University Teaching Hospital, Sokoto, Nigeria
Usman M. Waziri, Department of Paediatrics, Usmanu Danfodiyo University Teaching Hospital, Sokoto, Nigeria
Bilkisu I. Garba, Department of Paediatrics, Usmanu Danfodiyo University Teaching Hospital, Sokoto, Nigeria
Yahaya Mohammed, Department of Medical Microbiology and Parasitology, Usmanu Danfodiyo University Teaching Hospital, Sokoto, Nigeria
Joy F. Legbo, Department of Paediatrics, Usmanu Danfodiyo University Teaching Hospital, Sokoto, Nigeria
Nazish P. Aquil, Department of Surgery, Usmanu Danfodiyo University Teaching Hospital, Sokoto, Nigeria
Fatima I. Abubakar, Department of Paediatrics, Usmanu Danfodiyo University Teaching Hospital, Sokoto, Nigeria
Memuna Omar, Department of Paediatrics, Usmanu Danfodiyo University Teaching Hospital, Sokoto, Nigeria

Abstract

Introduction: Ecthyma gangrenosum (EG) is a cutaneous lesion commonly caused by Pseudomonas aeruginosa that involves mainly the lower limbs and gluteal region, seen more in immunosuppressed patients with neutropenia. Cancrum oris (Noma) is a gangrenous necrosis of the face that begins as a gingival ulcer and progresses rapidly to destroy contiguous tissues in malnourished children.

Case Presentation: This article reports a case of facial EG which was similar to Noma in a malnourished child: a 16-month old girl with fever, cough, weight loss, watery stool and swelling on right cheek. She was febrile, pale, wasted with bilateral pitting pedal oedema. She had a solitary circumscribed round necrotic lesion, with surrounding hyperaemia on the right malar area which extended to destroy the right ala nasi. No intra-oral rashes but she had left ear discharge. She received blood transfusion, antibiotics, antiseptic wound care and nutritional rehabilitation.

Management and Outcome: Swabs of the lesion and ear discharge both revealed Gram-negative bacilli and culture yielded P. aeruginosa. Retroviral, Mantoux and Gene Xpert tests were negative. She had moderate anaemia, normal white blood cell count, and neutropaenia. Parenteral ceftriazone was changed to ciprofloxacin based on sensitivity results and lack of clinical response. The wound healed with residual scarring and partial destruction of right ala nasi.

Discussion: Although this patient had facial necrosis to suggest Noma, she did not have initial oral involvement, and clinical features such as Pseudomonas sepsis and neutropaenia suggested EG. Facial necrosis in malnourished children may be due to EG.


Keywords

ecthyma gangrenosum; Pseudomonas; malnourished child; noma; Sokoto

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