Ecthyma Gangrenosum of the Groin Resistant to Ciprofloxacin, Cefepime, Metronidazole, and Meropenem. What's Next?

Abstract Ecthyma gangrenosum is a cutaneous infection characterized by gangrenous ulcers with erythematous borders. Bacterial invasion of arterial media, adventitia, and veins promotes ischemic necrosis. Pseudomonas aeruginosa is the most frequently identified organism, although other bacterial and fungal pathogens have been implicated. The risk of ecthyma gangrenosum development and infection prolongation is increased among immunocompromised and neutropenic patients. While eradication requires source control and wound closure, neutropenic patients are poor surgical candidates due to low leukocytes and poor graft uptake. Furthermore, a prolonged neutropenic state provides ample access of enteric flora to the broad-spectrum-treated wound, promoting multidrug-resistant strains. Here, we present a fatal case of multidrug-resistant ecthyma gangrenosum in a neutropenic patient with acute myeloid leukemia. We emphasize the importance of leukopenia resolution for recovery, which is often not achieved in prolonged neutropenic patients.