Periocular ecthyma gangrenosum with Pseudomonas septicemia in an infant: A case report

Ecthyma gangrenosum is a skin manifestation of fatal septicemia. We report a case of periocular ecthyma gangrenosum, which is an uncommonly infected area and rarely reported in infants. A 1-month-old female infant with periocular ecthyma gangrenosum presented with a high-grade fever and acute left medial canthus of the eyelid swelling and erythema. Hemoculture at 6 h confirmed Pseudomonas aeruginosa infection. Intravenous and topical antibiotics were administered. Daily dressing of the wound and noninvasive bedside escharectomy were performed. Cosmetically acceptable scar was achieved without additional surgery. The patient was considered to have congenital neutropenia due to persistent neutropenia and severe skin and mucosal infections in her first year of life. Noninvasive debridement of the wound reduces the risk of exposure keratitis, lacrimal drainage pathway damage, and the need for further surgical reconstruction. The cause of compromised immunity in infants with ecthyma gangrenosum should be investigated, and intensive follow-up is recommended.