Double atypical co-infection in ecthyma gangrenosum: a peculiar case report.

Introduction: Ecthyma gangrenosum (EG) is a rare cutaneous manifestation commonly associated with Pseudomonas aeruginosa infection in immunocompromised individuals. Additionally, different bacterial and fungal pathogens have also been identified. However, co-infection on EG lesions has never been reported before. Case report: We present the case of a seven-year-old female Asian patient who initially was diagnosed with febrile neutropenia. Initially, on the sixth day of admission, dermatological status revealed multiple painless erythematous macules on the face and arms together with persistent fever followed by evolution to multiple black, deep-seated, and large central eschars and early identification of Pseudomonas aeruginosa in the blood culture. Further evaluation revealed the development of EG with XDR Acinetobacter baumannii and Aspergillus spp. isolated from the samples harvested intraoperatively. Conclusions: Specific identification of etiological agents will serve its importance for early diagnosis, aggressive antibiotic treatment, and/or surgical intervention to improve the prognosis. GERMS.