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Ecthyma-like Skin Lesions Caused by Staphylococcus aureus

Dorothy Turnbull, MD; Michael F. Parry, MD
Arch Intern Med. 1981;141(5):689. doi:10.1001/archinte.1981.00340050135033.
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To the Editor.  —Ecthyma gangrenosum is an uncommon but dramatic physical finding. It has been described as a classic sign of Pseudomonas sepsis, but recent reports indicate that similar skin lesions may be produced by Aeromonas hydrophila, lactosepositive vibrios, and perhaps other Gram-negative bacilli and fungi.1-3 We would like to report the occurrence of necrotic skin lesions in two patients with systemic Staphylococcus aureus infection. Both patients with hematologic malignant neoplasms were profoundly immunosuppressed and had skin lesions clinically indistinguishable from those described in Pseudomonas sepsis.

Report of Cases.—Case 1.  —A 68-year-old man with erythroleukemia and neutropenia was admitted to the hospital with acute onset of fever and dyspnea.Physical examination revealed a temperature of 38.9 °C, petechiae on the lower extremities, and three ecthyma-like lesions on the back and a forearm (Figure). The WBC count was 500/cu mm.Cultures of blood and skin lesions showed growth

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