Septic shock with round necrotic skin lesions

Excerpt

A 25-year-old male with a history of Hodgkin lymphoma under chemotherapy was admitted to the intensive care unit for septic shock in a context of aplasia, requiring crystalloid and norepinephrine infusion. There was no obvious source of sepsis excepted for a painful necrotic papule noted on the left thigh, surrounded by erythema (Fig. 1a). Meticulous skin inspection showed two similar lesions behind the head (Fig. 1b). Urgent antibiotic therapy associating piperacillin-tazobactam, amikacin and vancomycin was started. Given the possibility of invasive infection with candida or fusarium, amphotericin B was added. We considered that necrotizing fasciitis was unlikely and did not perform surgical exploration. Blood cultures were associated with biopsy of skin lesions. One day later, the patient was weaned from vasopressors, with complete resolution of the shock state. Pseudomonas aeruginosa was identified on blood cultures and skin samples. Anatomopathologic analysis of skin samples showed a leukocytoclastic vasculitis.

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