Ecthyma Gangrenosum in a Preterm Neonate with Early-Onset Sepsis: A Case Report

Abstract

Ecthyma gangrenosum (EG) is a rare but fatal condition in preterm babies with characteristic skin manifestations primarily associated with critically ill and immunocompromised states, often caused by Pseudomonas aeruginosa (Pa) infection but also resulting from various other bacterial and fungal pathogens. This case report describes ecthyma gangrenosum in a preterm (31 weeks), low-birth-weight (1.8 kg) neonate with early-onset neonatal sepsis (EONS) born to a primigravida mother with prolonged premature rupture of membranes (PROM). On the second day of life, multiple erythematous cutaneous lesions appeared and rapidly evolved into characteristic necrotic ulcers, accompanied by systemic manifestations of sepsis. Diagnostic challenges included the overlap of EG symptoms with other neonatal skin conditions and the absence of positive culture results. Despite these challenges, prompt recognition and initiation of broad-spectrum antibacterial therapy, supportive measures, and multidisciplinary care resulted in clinical improvement with eventual discharge on oral linezolid on the 17^th day in healthy condition. This case highlights the importance of early recognition of EG in neonates, necessitating early initiation of appropriate therapy and close monitoring for improved outcomes in this vulnerable population. Further research is needed to enhance understanding and optimize management strategies for EG in neonatal sepsis.