Jamal Aisha, Saleem Ali, Rezwan Faiza, Sheikh Affaf, Shamsi Tahir
Department of Clinical Haematology, National Institute of Blood Diseases and Bone Marrow Transplantation, Karachi, Pakistan.
Department of Research & Development, National Institute of Blood Diseases and Bone Marrow Transplantation, Karachi, Pakistan.
SAGE Open Med Case Rep. 2022 May 25;10:2050313X221102113. doi: 10.1177/2050313X221102113. eCollection 2022.
Pseudomonal ecthyma gangrenosum is a well-known condition in immunosuppressed patients. However, ecthyma gangrenosum associated with is a rare entity that requires early recognition and optimal antibiotic and surgical management. We herein report the first case of colistin & carbapenem-resistant ecthyma gangrenosum in an acute myeloid leukemia patient. A 30-year-old female with acute myeloid leukemia received induction chemotherapy at the National Institute of Blood Diseases and Bone Marrow Transplantation hospital. Post-chemotherapy, she developed fever and a necrotic erythematous papule on right forearm. Colistin-susceptible carbapenem-resistant was isolated in cultures. Susceptibility testing was performed by microbroth dilution method. Worsening necrotic lesion prompted surgical debridement. Histopathology of debrided tissue revealed necrotic inflammation, and tissue cultures grew colistin-resistant carbapenem-resistant (colistin minimum inhibitory concentration >4 µg/mL). We speculate that colistin resistance was acquired due to impaired antibiotic penetration in necrotic nidus. A higher incidence of carbapenem-resistant associated ecthyma gangrenosum is anticipated in hem-oncology patients, and timely diagnosis, appropriate antibiotics, and surgical debridement remain the only potential cure.
铜绿假单胞菌坏疽性脓皮病在免疫抑制患者中是一种众所周知的病症。然而，与[此处原文缺失相关内容]相关的坏疽性脓皮病是一种罕见的情况，需要早期识别以及最佳的抗生素和手术治疗。我们在此报告了首例急性髓系白血病患者发生的对黏菌素和碳青霉烯耐药的铜绿假单胞菌坏疽性脓皮病。一名30岁的急性髓系白血病女性患者在国家血液疾病和骨髓移植医院接受诱导化疗。化疗后，她出现发热，右前臂出现坏死性红斑丘疹。培养物中分离出对黏菌素敏感但对碳青霉烯耐药的铜绿假单胞菌。通过微量肉汤稀释法进行药敏试验。坏死病变的恶化促使进行手术清创。清创组织的组织病理学显示坏死性炎症，组织培养物中生长出对黏菌素耐药且对碳青霉烯耐药的铜绿假单胞菌（黏菌素最低抑菌浓度>4μg/mL）。我们推测黏菌素耐药是由于抗生素在坏死病灶中渗透受损所致。预计血液肿瘤患者中耐碳青霉烯类相关坏疽性脓皮病的发病率会更高，及时诊断、使用合适的抗生素和手术清创仍然是唯一可能的治愈方法。
