Ecthyma Gangrenosum Secondary to Multidrug-Resistant Gram-Negative Rod Infections in Leukemia Patients With Prolonged Neutropenia

Ecthyma gangrenosum is a cutaneous infection classically associated with Pseudomonas aeruginosa as the causative pathogen, but other gram-negative enteric flora can be found. This infection is typically seen in immunocompromised patients in the setting of fulminant bacteremia with lesional features of gangrenous ulceration surrounded by tender erythematous borders. In patients with hematological malignancies, prompt recognition of this entity through microbiological and clinical features is critical to ensuring successful treatment and resolution. As patients with refractory leukemia live longer with breakthroughs in therapy, infectious complications are becoming more common along with increasing resistant gram-negative pathogens. Herein, we present 9 cases of ecthyma gangrenosum caused by multidrug-resistant gram-negative bacteria in leukemia patients with prolonged neutropenia, which were successfully managed with combination antibiotic therapy.