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VOLUME 16 , ISSUE 1 ( January-April, 2024 ) > List of Articles


Necrotic Lesions in Infants: Ear, Nose, and Throat Manifestations

Kavita Sachdeva, Aparaajita Upadhyay, Neeraj Sachdeva

Keywords : Case report, Ecthyma gangrenosum, Infantile febrile illness, Pseudomonas aeruginosa

Citation Information : Sachdeva K, Upadhyay A, Sachdeva N. Necrotic Lesions in Infants: Ear, Nose, and Throat Manifestations. Int J Otorhinolaryngol Clin 2024; 16 (1):29-32.

DOI: 10.5005/jp-journals-10003-1499

License: CC BY-NC 4.0

Published Online: 11-04-2024

Copyright Statement:  Copyright © 2024; The Author(s).


Aim: To describe a unique finding of necrotic lesions of the peripheral aspect of the body affecting the nose and ears in sporadic cases admitted in the pediatric ward at our center. Background: Infants till 4 months are immune to viral infections. However, a severe viral infection may lead to rapid deterioration with secondary bacteremia. Pseudomonas infection is frequently complicated by necrotic lesions of the periphery, namely, ecthyma gangrenosum (EG). This case series includes five cases which were sporadic coming from suburban areas of two districts of Madhya Pradesh. Case description: All five cases of the age group between 1 month and 10 months had presented with a short history of high-grade fever of 4–6 days, soon followed by the appearance of rashes. Rashes were maculopapular involving thighs and, buttocks with some cases involving the nose and ears. The patients were admitted to the pediatric ward and a complete hemogram, blood sugar, urine analysis, cerebrospinal fluid (CSF) culture, pus culture, antineutrophil cytoplasmic antibodies (C-ANCA) test, and biopsy were done. Antibiotic coverage was immediately started and response was observed. Conclusion: The skin lesions affecting infants associated with fever and rash are very typical in presentation. In this series, the necrotic lesions are peculiar with the involvement of the nose and ears along with the peripheral region. These cases were primarily diagnosed by presentation and confirmed by biopsy and other investigations. Three cases improved while two patients died. Such cases were not seen prior to the study period nor seen later. Ecthyma gangrenosum was concluded to be the final diagnosis comparable to the clinical picture in most cases both with and without bacteremia. Clinical significance: Infantile febrile lesions with skin lesions are a rare clinical entity that should be reported early. They are primarily diagnosed by clinical presentation. If managed timely, serious complications can be avoided.

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  1. Bastuji–Garin S, Rzany B, Stern RS, et al. Clinical classification of cases of toxic epidermal necrolysis, Stevens–Johnson syndrome, and erythema multiforme. Arch Dermatol 1993;129:92–96. DOI: 10.1001/archderm.129.1.92.
  2. Michael MB, Smoller BR, Somach SC. Ecthyma Gangrenosum. Deadly Dermatologic Diseases: Clinicopathologic Atlas and Text, 1st edition. New York: Springer; 2007, pp. 121–124.
  3. Huminer D, Siegman–Igra Y, Morduchowicz G, et al. Ecthyma gangrenosum without bacteremia. Report of six cases and review of the literature. Arch Intern Med 1987;147(2):299–301. DOI: 10.1001/archinte.147.2.299.
  4. Bhat RM, Nandakishore B, Sequeira FF, et al. Pyoderma gangrenosum: An Indian perspective. Clin Exp Dermatol 2011;36(3):242–247. DOI: 10.1111/j.1365-2230.2010.03941.x.
  5. El Baze P, Thyss A, Vinti H, et al. A study of nineteen immunocompromised patients with extensive skin lesions caused by Pseudomonas aeruginosa with and without bacteremia. Acta Derm Venereol 1991;71(5):411–415. PMID: 1684470.
  6. Powell FC, Su WP, Perry HO. Pyoderma gangrenosum: Classification and management. J Am Acad Dermatol 1996;34(3):395–409. DOI: 10.1016/s0190-9622(96)90428-4.
  7. Bhat RM. Management of pyoderma gangrenosum: An update. Indian J Dermatol Venereol Leprol 2004;70(6):329–335. PMID: 17642657.
  8. Martin–Ancel A, Borque C, del Castillo F. Pseudomonas sepsis in children without previous medical problems. Pediatr Infect Dis J 1993;12:258–260. DOI: 10.1097/00006454-199303000-00022.
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