Professional Documents
Culture Documents
1 s2.0 S1201971211000063 Main
1 s2.0 S1201971211000063 Main
1 s2.0 S1201971211000063 Main
Case Report
Department of Dermatology, Rouen University Hospital, 1 rue de Germont, F 76031 Rouen Cedex, France
Department of Infectious Diseases, Rouen University Hospital, University of Rouen, France
A R T I C L E I N F O
S U M M A R Y
Article history:
Received 11 August 2010
Accepted 20 December 2010
Suppurative panniculitis usually occurs among immunocompromised patients and can be caused by
opportunistic pathogens or by secondary infectious lesions in the context of septicemia. Herein we
report the case of an 82-year-old woman with multiple red nodules on the leg caused by Pseudomonas
aeruginosa, not related to a blood disseminated infection. The present case represents an unusual
presentation of indolent suppurative panniculitis caused by P. aeruginosa.
2011 International Society for Infectious Diseases. Published by Elsevier Ltd. All rights reserved.
Introduction
Pseudomonas aeruginosa is often recognized as an opportunistic
pathogen in hospitalized and debilitated patients, causing primary
bacteremia or septicemia, endocarditis, pneumonia, abscesses, and
wound infections. Cutaneous manifestations associated with P.
aeruginosa can present as non-severe infections such as folliculitis or
severe infections such as ecthyma gangrenosum in the context of
septicemia. Indolent infectious nodules are frequent in immunocompromised patients, usually involving fungi, parasites, or slowgrowing bacteria. We describe herein an unusual clinical indolent
presentation of a disseminated cutaneous infection by P. aeruginosa.
Case report
An 82-year-old female patient was referred for a 1-week history
of nodules on her right leg. Her previous medical history included:
diabetes mellitus, hypercholesterolemia, high blood pressure,
coronary artery disease, atrial brillation, stage IV arteriosclerosis
obliterans according to the LericheFontaine classication that had
required a prosthetic crossover femoropopliteal bypass 3 months
earlier, chronic renal insufciency (diabetic nephropathy and
hypertensive nephroangiosclerosis), and a hysterectomy for
uterine neoplasia. On presentation, the patient had no fever and
was hemodynamically stable. Clinical examination showed
multiple painful redpurple nodules on the right leg and an
inguinal lymphadenopathy (Figure 1). The patient also had an
arterial ulcer on the external side of the right foot; distal pulses
1201-9712/$36.00 see front matter 2011 International Society for Infectious Diseases. Published by Elsevier Ltd. All rights reserved.
doi:10.1016/j.ijid.2010.12.007
e290
The authors thank Richard Medeiros, Rouen University Hospital, medical editor, for editing the manuscript.
References
1. Llistosella E, Ravella A, Moreno A, de Moragas JM. Panniculitis in Pseudomonas
aeruginosa septicemia. Acta Derm Venereol 1984;64:4479.
2. Bagel J, Grossman ME. Subcutaneous nodules in Pseudomonas sepsis. Am J Med
1986;80:5289.
3. Bourelly PE, Grossman ME. Subcutaneous nodule as a manifestation of Pseudomonas sepsis in an immunocompromised host. Clin Infect Dis 1998;26:1889.
4. Schlossberg D. Multiple erythematous nodules as a manifestation of Pseudomonas aeruginosa septicemia. Arch Dermatol 1980;116:4467.
5. El Baze P, Thyss A, Vinti H, Deville A, Dellamonica P, Ortonne JP. A study of
nineteen immunocompromised patients with extensive skin lesions caused by
Pseudomonas aeruginosa with and without bacteremia. Acta Derm Venereol
1991;71:4115.