Reactions 1413 - 4 Aug 2012

SAntineoplastics

Febrile neutropenia leading to ecthymagangrenosum: case report

A 41-year-old man with B-cell lymphoma developedecthyma gangrenosum secondary to chemotherapy-induced febrile neutropenia [routes, dosages and outcomesnot stated].

The man was hospitalised with febrile neutropenia whilereceiving chemotherapy with cyclophosphamide,doxorubicin, vincristine, prednisone and rituximab. He wassuccessfully treated with metronidazole and piperacillin/tazobactam. Twelve days after completing his sixth cycle ofchemotherapy, he presented to the emergency departmentwith a 3-week history of erythematous skin lesions on histrunk, arms and legs, accompanied by a 2-day history ofmalaise, fever and diarrhoea. Despite initial treatment withclindamycin, his skin lesions had not improved. Uponadmission, he had a temperature of 40°C, BP of90/50mm Hg, HR of 120 beats/min and a respiratory rate of32 breaths/min. Laboratory investigations included thefollowing: leukocyte count 1.0 × 103 cells/mm3, absoluteneutrophil count 0.7 × 103 cells/mm3, platelet count63 × 103 cells/mm3, haemoglobin 6.9 g/dL and creatinine4.4 mg/dL. A large lesion on his right thigh was consistentwith ecthyma gangrenosum, and a bacterial infection wassuspected. Blood and skin cultures yielded Pseudomonasaeruginosa.

The man was treated with ciprofloxacin and piperacillin/tazobactam. He subsequently underwent debridement ofseveral necrotic skin lesions, followed by skin grafting tothe abdomen, right arm and right thigh.

Author comment: "[I]n patients receiving chemotherapy,mucosal injury and neutropenia may result in bacteremiawith secondary hematogenous seeding of the skin."Moayedi Y, et al. From the outside looking in. American Journal of Medicine 125:457-60, No. 5, May 2012 - Canada 803074814

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Reactions 4 Aug 2012 No. 14130114-9954/10/1413-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved