Case Number : CASE 4505 - 26 April 2024 Posted By: Admin_Dermpath

Could it be Behçet's disease?

FOUND THIS: 

Libman BS, Quismorio FP Jr, Stimmler MM. Polyarteritis nodosa-like vasculitis in human immunodeficiency virus infection. J Rheumatol. 1995 Feb;22(2):351-5. PMID: 7738964.

super 

Ecthyma gangrenosum.

Ecthyma gangrenosum.

Ecthyma gangrenosum.

Pyoderma gangrenosum

Pyoderma gangrenosum

Invasive fungal infection

Thank you for your comments. 

The final diagnosis is:  Ecthyma gangrenosum. Please see the special stain. 

The differential diagnoses to consider are:
Pyoderma gangrenosum
Chronic herpetic ulceration
Purpura fulminans
Invasive fungal infection
 

On 21/05/2024 at 16:43, Admin_Dermpath said:

Thank you for your comments. 

The final diagnosis is:  Ecthyma gangrenosum. Please see the special stain. 

The differential diagnoses to consider are:
Pyoderma gangrenosum
Chronic herpetic ulceration
Purpura fulminans
Invasive fungal infection
 

Can you elaborate on the special stain?  I take it it is a Gram stain showing Gram negative bacilli, and obviously not ZN or Wade-Fite.  Were the organisms identified microbiologically? 

Surprisingly there is only one previous post of ecthyma gangrenosum on this website, given the fact that ecthyma is relatively common and often causes diagnostic confusion.  This was case 918 posted on 27.12.13 by Richard Carr, but it may no longer be visible.  That case was caused by Pseudomonas aeruginosa, so perhaps this was also the causative organism here.