Pseudomonas septicemia. Illustrated evolution of its skin lesion

Pseudomonas aeruginosainfections continue to present a formidable challenge because of the high incidence in patients with chronic disease and impaired defense mechanisms, and the resistance of the organism to most antibiotics. In particular,Pseudomonassepticemia is a dread complication which can be effectively treated only if recognized early. A feature that is helpful in making the diagnosis ofPseudomonassepticemia is the presence of a characteristic skin lesion commonly known as ecthyma gangrenosum. This lesion was first described by Barker1in 1897 and subsequently noted by other authors to be pathognomonic ofPseudomonassepticemia.2-4Illustrated descriptions of the clinical and microscopic features of this lesion are sparse. We recently saw a patient with multiple myeloma who developed striking skin lesions associated withPseudomonassepticemia. The clinical and histopathological observations of this case provide the basis for this report. Patient Summary A 60-year-old man with multiple myeloma