scholarly journals Ecthyma gangrenosum in a patient with febrile pancytopenia

2022 ◽  
Vol 13 (1) ◽  
pp. 98-98
Author(s):  
Samia Mrabat ◽  
Hanane Baybay ◽  
Ryme Dassouly ◽  
Zakia Douhi ◽  
Sara Elloudi ◽  
...  
Keyword(s):  
Septic Shock ◽  
Plasma Cells ◽  
Maculopapular Rash ◽  
Severe Thrombocytopenia ◽  
Immunocompromised Patients ◽  
Cutaneous Infection ◽  
Left Flank ◽  
Ecthyma Gangrenosum ◽  
Dermatological Examination ◽  
Hemorrhagic Bullae

Ecthyma gangrenosum (EG) is a cutaneous infection most commonly associated with Pseudomonas bacteremia and usually occurring in immunocompromised patients [1]. The infection progresses sequentially from a maculopapular rash to hemorrhagic bullae, then to necrotic ulcerations with surrounding erythema [2]. Herein, we report a case of ecthyma gangrenosum in an immunologically compromised patient. A 65-year-old female was admitted to the oncohematology department for febrile pancytopenia. Blood work revealed severe thrombocytopenia at 15,000/mm³), an absolute neutrophil count of 180 cells/mm³, and anemia. A sternal bone marrow puncture found 15% of plasma cells. Four days after the admission, the patient had a painful, quickly extending lesion on the abdomen. She described erythema that progressed to pustules, then ulcerations. On general clinical evaluation, the patient was feverish at 40°C. A dermatological examination revealed the presence of a 6 cm purpuric patch on the left flank with a central necrotic eschar (Fig. 1). The diagnosis of ecthyma gangrenosum was reached and the patient was treated with ceftazidime and vancomycin. Unfortunately, having gone into septic shock, the patient died one week later.

CLINICAL FEATURES AND COAGULATION ABNORMALITIES IN CHILDREN WITH SEPSIS AT DANANG HOSPITAL FOR WOMEN AND CHILDREN

2018 ◽  
pp. 97-103
Author(s):  
Huu Hoi Vo ◽  
Binh Bao Son Bui
Keyword(s):  
Septic Shock ◽  
Clinical Features ◽  
Cross Sectional Study ◽  
Severe Thrombocytopenia ◽  
Cross Sectional ◽  
Hematologic Tests ◽  
Coagulation Abnormalities ◽  
Women And Children ◽  
Key Words Coagulation ◽  
Coagulation Dysfunction

Objective: To determine the relationship between coagulation abnormalities and main clinical features, and hematologic tests. Methods: A descriptive cross-sectional study was conducted in 65 children with sepsis at the PICU, Da Nang Hospital for Women and Children from April 2012 to June 2013. Results: The frequency of internal hemorrhage in septic shock children was significantly higher than in children with sepsis (p < 0.001). The rate of thrombocytopenia was 30.8%, in which 10.8% of the children had severe thrombocytopenia (<50 x 109/l). Hypofibrinogenemia was observed in 30.8% of the patients, in which severe hypofibrinogenemia (≤ 1 g/l) was observed in 16.9% of the children. The frequency of reduced prothrombin ratio was 40%, in which 23.1% of the patients had prothrombin ratio < 50%. 35.4% of the patients had rAPTT > 1.15. Positive D-dimer and DIC were observed in 53.8% and 20% of the patients, respectively. Hemostatic changes showed the significant relationship with hemorrhage and the mortality of sepsis. Conclusion: Children with sepsis, especially septic shock were at high risk of coagulation dysfunction and coagulation abnormalities showed the correlation with hemorrhage and the mortality of sepsis. Key words: coagulation abnormalities, sepsis, children

Machine Learning Algorithms to Predict the Mortality of Carbapenem Resistant Klebsiella Pneumoniae bacteremia

2019 ◽  
Author(s):  
Qiqiang Liang ◽  
Fang Qian ◽  
Yibing Chen ◽  
Zhijun Xu ◽  
Zhijiang Xu ◽  
...  
Keyword(s):  
Machine Learning ◽  
Risk Factors ◽  
Septic Shock ◽  
High Risk ◽  
Klebsiella Pneumoniae ◽  
Severe Thrombocytopenia ◽  
Acute Renal Injury ◽  
High Risk Factors ◽  
Carbapenem Resistant ◽  
Logical Regression

Abstract Purpose To establish mortality prediction models in 14 days of Carbapenem-Resistant Klebsiella Pneumoniae bacteremia using Machine learning.Materials and Methods It is a single-center retrospective study. We collect the relevant clinical information of all patients with Carbapenem-Resistant Klebsiella Pneumoniae (CRKP) bacteremia in the past 5 years using the local database. Data analysis and verification are carried out by multiple logical regression, decision tree, random forest, support vector machine (SVM), and XGBoost.Result This study includes 187 patients with 40 related variables. In multiple logical regression, acute renal injury (P=0.003), Apache II score (P=0.036), immunodeficiency (P=0.025), severe thrombocytopenia (P=0.025) and septic shock (P=0.044) are the high-risk factors for 14 days mortality of CRKP bloodstream infections. According to the importance of those parameters, risk scoring is established to predict the survival rate of CRKP bacteremia. The analysis of the five models, with 70% training set and 30% test set, show the comprehensive performance of random forest (AUROC=0.953, precision=91.85%) is slightly better than that of XGBoost (AUROC=0.912, precision=86.41%) and SVM (AUROC=0.936, precision=79.89%) in predicting 14-day mortality of CRKP bacteremia. The multiple logical regression model (AUROC=0.825, precision=81.52%) is the second, and the decision tree model (AUROC=0.712, precision=79.89%) is not very ideal.Conclusion Machine learning has good performances in predicting 14-day mortality of CRKP bacteremia than multiple logical regression. Acute renal injury, severe thrombocytopenia, and septic shock are the high-risk factors of CRKP bacteremia mortality.

scholarly journals Multiple liver abscesses caused by Streptococcus intermedius bacteremia in the setting of a routine dental cleaning

2020 ◽  
Vol 13 (2) ◽  
pp. e233097 ◽  
Author(s):  
Angy Hanna ◽  
Zaid Imam ◽  
Fadi Odish ◽  
Bhavin Dalal
Keyword(s):  
Septic Shock ◽  
Gastrointestinal Tract ◽  
Immunocompetent Patient ◽  
Blood Cultures ◽  
Immunocompromised Patients ◽  
Ultrasound Guided ◽  
Streptococcus Intermedius ◽  
Liver Abscesses ◽  
The Brain ◽  
Gram Positive Cocci

Streptococcus intermedius is a Gram-positive cocci, normally found in the oral cavity and gastrointestinal tract. It has been associated with deep-seated purulent abscesses commonly in the brain or liver in immunocompromised patients. Here, we discuss the case of a 21-year-old immunocompetent patient that presented with septic shock in the setting of multiple pyogenic liver abscesses with positive blood cultures for S. intermedius. The patient had a dental cleaning 3 months prior to admission. The abscesses resolved with ultrasound guided drainage and antibiotic therapy.

Septic shock related to community-acquired pneumonia with ecthyma gangrenosum

2019 ◽  
Vol 49 (4) ◽  
pp. 288-289
Author(s):  
O. Passouant ◽  
M. Hentzien ◽  
M. Viguier ◽  
V. Vernet-Garnier ◽  
F. Bani-Sadr ◽  
...  
Keyword(s):  
Septic Shock ◽  
Community Acquired Pneumonia ◽  
Ecthyma Gangrenosum

Platelets Protect From Lipopolysaccharide-Induced Lethal Endotoxemia by Inhibiting Macrophage-Dependent Inflammation Via the Cyclooxygenase 1 (COX1) Signaling Pathway

Blood ◽  
2012 ◽  
Vol 120 (21) ◽  
pp. 93-93
Author(s):  
Binggang Xiang ◽  
Guoying Zhang ◽  
Xiang-An Li ◽  
Andrew J. Morris ◽  
Alan Daugherty ◽  
...  
Keyword(s):  
Septic Shock ◽  
Platelet Transfusion ◽  
Conflicts Of Interest ◽  
Plasma Concentrations ◽  
Platelet Inhibition ◽  
Severe Thrombocytopenia ◽  
Wild Type ◽  
Activated Platelets ◽  
Platelet Depletion

Abstract Abstract 93 Sepsis is a tremendous burden for health-care systems. Patients with sepsis often have low platelet counts, and septic patients with severe thrombocytopenia have a poor prognosis and higher mortality. However, the role of platelets in the pathogenesis of sepsis has not been well elucidated. We investigated the role of platelets in septic shock using a mouse model of lipopolysaccharide (LPS)-induced endotoxemia. Depletion of platelets by intraperitoneal injection of a rat anti-mouse GPIb monoclonal antibody increased mortality and aggravated organ failure in endotoxemic mice as evident by increases in plasma aminotransferase (ALT), aspartate aminotransferase (AST), Lactate dehydrogenase (LDH), and Creatine kinase (CK) concentrations, while transfusion of platelets reduced mortality. Increases in mortality rate in thrombocytopenic mice by LPS challenge was not due to inflammatory hemorrhage, because there was no significantly hemorrhage observed in brains and lungs from mice pre-treated with either control IgG or the anti-GPIba antibody and blood RBC and Hb concentrations between IgG pre-treated mice and the anti-GPIba antibody pre-treated mice were similar. TNF-a, which is produced mainly by macrophages in vivo, plays critical roles in the development of disseminated intravascular coagulation, acute respiratory distress syndrome and shock in sepsis. Our data indicate that plasma concentrations of proinflammatory cytokines, TNF-a and IL-6, were markedly increased by platelet depletion and decreased by platelet transfusion in the mice challenged with LPS. Effects of platelet depletion on TNF-a production were eliminated in the mice that macrophages were pre-depleted. Furthermore, LPS- or thrombin-activated platelets or releasates from activated platelets inhibited TNF-a and IL-6 production in macrophages in vitro. Inhibition of TNF-a and IL-6 production in macrophages by activated platelets was prevented by pre-incubation of platelets with a COX1 inhibitor aspirin. Moreover, platelets from wild type mice but not COX1 deficient mice inhibited LPS-induced TNF-a and IL-6 production in macrophages. Transfusion of COX1 deficient platelets failed to protect against endotoxemia. Washed platelets from wild-type mice or platelet releasates from thrombin-activated wild-type mice inhibited LPS-induced TNF-a and IL-6 production in macrophages lacking TXA2 receptor, TP, suggesting that a metabolite other than TXA2 is responsible for platelet inhibition of macrophage function. We found that stimulation of platelets with thrombin or LPS induced PGE2 production and pre-incubation of macrophages with an antagonist of PGE2 receptor EP4 reversed platelet inhibition on TNF-a and IL-6 production in macrophages. Our results indicate that platelets protect against septic shock by inhibiting macrophage-dependent inflammatory response via the COX1/PGE2/EP4 dependent pathway. Thus, these findings demonstrate a previously unappreciated role for platelets in septic shock and suggest that platelet transfusion may be effective in treating septic patients. Disclosures: No relevant conflicts of interest to declare.

scholarly journals The Association Between Dynamic Changes in Serum Presepsin Levels and Mortality in Immunocompromised Patients with Sepsis: A Prospective Cohort Study

2020 ◽  
Author(s):  
Jongmin Lee ◽  
Seo Hyun Kim ◽  
Kyung Hoon Kim ◽  
Na Ri Jeong ◽  
Seok Chan Kim ◽  
...  
Keyword(s):  
Septic Shock ◽  
Cohort Study ◽  
Hospital Mortality ◽  
Prospective Cohort Study ◽  
Prospective Cohort ◽  
Area Under The Curve ◽  
Immunocompromised Patients ◽  
Dynamic Changes ◽  
Saps 3 ◽  
Sepsis And Septic Shock

Abstract Background: Presepsin is a subtype of soluble CD14 that is increased in the blood of septic patients. We investigated the role of dynamic changes in serum presepsin levels in critically ill, immunocompromised patients with sepsis.Methods: This is a prospective cohort study that included 119 adult patients who were admitted to the intensive care unit (ICU) between March 2019 and June 2020. Sepsis and septic shock were defined as Sepsis-3. Patients were classified into one of the following diagnostic groups: no sepsis, sepsis, and septic shock. Presepsin level was measured on day 1 and day 3 after ICU admission. The primary outcome was in-hospital mortality.Results: Of the 119 patients, sepsis was diagnosed in 40 patients (33.6%) and septic shock was diagnosed in 60 (50.4%) patients. The Simplified Acute Physiology Score (SAPS) 3 and Sequential Organ Failure Assessment score on day 1 were 75.5 ± 14.9 and 9.0 (6.5–11.5), respectively, and the overall hospital mortality was 44.5%. In 61 immunocompromised patients, presepsin levels on day 1 were higher in patients with sepsis than those in patients without sepsis (1203.0 [773.0–2484.0] vs. 753.0 [603.5–1092.0] ng/ml; P = 0.004). The area under the curve (AUC) of presepsin for diagnosing sepsis in immunocompromised patients was 0.87, which was comparable with that of procalcitonin (AUC, 0.892). Presepsin levels on day 3 were higher in patients who died in the hospital than in those who survived (1965.0 [1149.0–3423.0] vs. 933.0 [638.0–1571.0]; P = 0.001). In immunocompromised patients who died in the hospital, presepsin levels on day 3 were significantly higher than those on day 1 (P = 0.018). In the multivariate analysis, ΔPresepsin+ (ΔPresepsin concentrations [day3 – day1] > 0) alone was independently correlated with in-hospital mortality in immunocompromised patients (odds ratio, 6.22; 95% confidence interval, 1.33–29.06; P = 0.020).Conclusion: These findings suggest that dynamic changes in presepsin levels between day 1 and day 3 are associated with in-hospital mortality in patients with sepsis, especially in immunocompromised patients.

Ibrutinib-associated necrotic nasal lesion and pulmonary infiltrates

2021 ◽  
Vol 14 (1) ◽  
pp. e237085
Author(s):  
Christopher Saling ◽  
Fionna Feller ◽  
Holenarasipur R Vikram
Keyword(s):  
Septic Shock ◽  
Pseudomonas Aeruginosa ◽  
Blood Culture ◽  
Lymphocytic Leukaemia ◽  
Invasive Pulmonary Aspergillosis ◽  
Necrotic Lesion ◽  
Tissue Necrosis ◽  
Pulmonary Aspergillosis ◽  
Ecthyma Gangrenosum ◽  
First Case

Herein, we report a case of a 68-year-old woman receiving ibrutinib for chronic lymphocytic leukaemia, who presented with septic shock and a progressive necrotic lesion on her nose. Surgical pathology of the nasal lesion revealed evidence of tissue necrosis, and both tissue and blood culture grew Pseudomonas aeruginosa. A diagnosis of ecthyma gangrenosum was made. Additional investigations also led to the discovery of invasive pulmonary aspergillosis. To our knowledge, this is the first case of ecthyma gangrenosum secondary to Pseudomonas sepsis and concurrent invasive pulmonary aspergillosis associated with ibrutinib use.

1709: ECTHYMA GANGRENOSUM AND SEPTIC SHOCK AS PRECEDING SYMPTOMS OF ACUTE LEUKEMIA

2016 ◽  
Vol 44 (12) ◽  
pp. 502-502
Author(s):  
Georgia Androutsopoulou ◽  
Gloria Heresi ◽  
Matthew Greives ◽  
Konstantinos Boukas
Keyword(s):  
Septic Shock ◽  
Acute Leukemia ◽  
Ecthyma Gangrenosum
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