Page 229 - Abstract Book KONIKA 18

Hemato-Oncology

P-HO-007
Acute Lymphoblastic Leukemia on Chemotherapy with Ecthyma Gangrenosum
as Skin Manifestation of Pseudomonas aeruginosa Bacteremia: A Case Report

Nia Astarina, Dina Garniasih, Fajar Subroto
Department of Child Health, Hematology Oncology Division, PKIAN RSAB Harapan Kita,
Jakarta, Indonesia

Abstract
Background Ecthyma gangrenosum is a rare and invasive cutaneous manifestation caused by Pseudomonas
aeruginosa (P. aeruginosa) and the mortality for patients with ecthyma gangrenosum ranges from 30% to
70%. Pseudomonas aeruginosa bacteremia occurs primarily in immunocompromised patients with severe
neutropenia like leukemia in children and are associated with a worse prognosis. Objective To describe
ecthyma gangrenosum caused by P. aeruginosa in a child with acute lymphoblastic leukemia (ALL) and to
point out on clinical significant this condition with high mortality rate. Case A girl 7-year-old with painful
erythematous skin lesions on the face, chest, abdomen, upper, and lower extremities. The lesions were
initially painless erythematous macule, become more painful, indurated, non-fluctuant and had been turning
into hemorrhagic bullae and necrotic with black eschar surrounding erythema. She had difficulty to walk
due to the pain. These lesions were associated with burning sensation. She had a history of ALL for the past
3 years and underwent chemotherapy for 2 years. the laboratory studies showed absolute neutrophil count
9
was 0.05 x 10 cells/L which revealed severe neutropenia, CRP 273 mg/L, and P. aeruginosa was found in
her blood culture. The bullae fluid culture revealed no growth of bacteria. She was treated with ceftazidime
and meropenem but unfortunately she had deterioration condition and died after 28 days hospitalization.
Conclusion It is important to carefully detect every single lesion in patient with hematological malignancy,
such as acute leukemia. Considering high rate of mortality, early diagnosis and prompt treatment is mandatory.

Figure 1. Ecthyma gangrenosum on the face, abdomen, lower extremities

Keywords: acute lymphoblastic leukemia; ecthyma gangrenosum; P. Aeruginosa, skin manifestation

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