Fatal Oculocutaneous Ecthyma Gangrenosum in Human Immunodeficiency Virus/Acquired Immunodeficiency Syndrome: Case Report and Review of the Literature

Abstract

Ecthyma gangrenosum (EG) is a rare, infective skin disease, predominantly but not exclusively caused by Pseudomonas aeruginosa. It is often seen in individuals with immunosuppression, although it has also been reported among previously healthy individuals. It was initially thought to be pathognomonic of P. aeruginosa septicemia, but this assertion was discarded following several reports on EG without bacteremia and EG with varied bacterial and fungal etiologies. There are scant reports of its association with human immunodeficiency virus (HIV) infection, while ocular involvement is extremely rare. An extensive search of the literature also found no report on EG, nor its relationship with HIV/acquired immunodeficiency syndrome (AIDS) from Sub-Saharan Africa. We hereby present a fatal case of multiple EG lesions in a 44-year-old Nigerian female with AIDS in the absence of bacteremia and review the literature of its association with HIV/AIDS and its concurrent orbital involvement.

Keywords: Acquired immunodeficiency syndrome; Pseudomonas aeruginosa; ecthyma gangrenosum; human immunodeficiency virus; panophthalmitis.

Figure 1

Right eye shows upper lid edema, mild erythema, and necrotic lesion on the nasal aspect of the right eye. The conjunctiva, cornea, and sclera appear necrotic

Figure 2

Multiple ulcers in different stages of evolution with some showing slough and islands of necrosis