Extensive Neonatal Ulcers Masquerading as Pyoderma Gangrenosum: A Rare Presentation of Severe Acinetobacter Infection

Acinetobacter species are opportunistic, multidrug-resistant pathogens that have emerged as significant causes of healthcare-associated infections. Although typically associated with pneumonia and septicemia in neonates, cutaneous presentations are exceedingly rare. We report a 14-day-old male neonate presenting with multiple rapidly progressive ulcerative skin lesions over the upper chest, initially suspected to be pyoderma gangrenosum, based on clinical morphology and histopathological findings. However, culture revealed multidrug-resistant Acinetobacter species in pus swabs. The infant responded dramatically to targeted antimicrobial therapy with piperacillin–tazobactam, confirming the diagnosis of an Acinetobacter -associated skin infection. This case highlights an unusual dermatologic manifestation of neonatal Acinetobacter infection and underscores the importance of early microbiological assessment and targeted therapy in managing atypical ulcerative lesions in neonates.