What is it about?
Ecthyma gangrenosum is a painful skin lesion that turns black in the centre (necrosis), surrounded by a red-purple halo. It appears mainly in people with very weak immune defences. We show the case of a 60-year-old woman with acute myeloid leukaemia who, during chemotherapy and with low white blood cells, developed a 1-cm necrotic sore on her shin, without fever. Blood tests showed inflammation, but blood cultures and fungal markers were negative. The lesion is classically caused by the bacterium Pseudomonas aeruginosa, but fungi such as Mucorales or Fusarium can look the same. She was immediately started on piperacillin/tazobactam and improved quickly; a skin biopsy culture confirmed Pseudomonas aeruginosa.
Featured Image
Photo by Michael Schiffer on Unsplash
Why is it important?
Recognizing this lesion at a glance can save lives: in immunocompromised patients it may signal a severe, rapidly progressing infection, sometimes even without fever or positive blood cultures. This clinical image reminds doctors to start empirical anti-Pseudomonas therapy immediately and to perform a skin biopsy with bacterial and fungal cultures to confirm the cause.
Perspectives
Clinical images are a powerful teaching tool: one look can stay in a young doctor's memory for an entire career. With Andrea Misin we wanted to share a classic but still frequently missed sign. In neutropenic patients, the skin can be the first window onto a life-threatening infection.
Professor Stefano Di Bella
Universita degli Studi di Trieste
Read the Original
This page is a summary of: Ecthyma gangrenosum in a neutropenic patient, Infection, April 2026, Springer Science + Business Media,
DOI: 10.1007/s15010-026-02788-w.
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