Ecthyma gangrenosum, a cutaneous manifestation of systemic infection.

A 55-year-old woman presented to our hospital with a painful scalp lesion. A day earlier, she had experienced scalp pain, swelling and redness that evolved into a deep purple lesion within hours. Eight days before, she had undergone chemotherapy for breast cancer. On presentation, her heart rate was 122 beats/min, temperature 39.2[degrees]C, blood pressure 120/56 mm Hg, and oxygen saturation 94% on room air. We saw a purpuric bulla measuring 1 cm * 2 cm with surrounding erythema on her scalp (Figure 1). Physical examination was otherwise unremarkable. The patient's leukocyte count was 0.30 (reference 3.5-10.8) * [10.sup.9]/L and absolute neutrophil count 0.008 (reference 1.5-8) * [10.sup.9]/L. We suspected ecthyma gangrenosum in the context of neutropenic sepsis and obtained blood from her port-a-cath and peripheral veins for culture, started empiric cefepime and admitted her for...