Skin and bone necrosis following ecthyma gangrenosum in acute leukaemia—report of three cases

Development in the treatment of acute leukaemia with aggressive chemotherapy followed by prophylactic cranial irradiation and maintenance chemotherapy has improved survival dramatically. Side-effects of treatment including haematological, gastrointestinal, immunological and neurological manifestations, are considerable, and may require aggressive management and supportive therapy. The combination of therapy and disease produces a profound granulocytopenia which generally predisposes patients to infection.¹ Oedema and cellulitis are the most frequent skin manifestations. This is presumably due to the immunosuppressive effects of the disease and the treatment of the inflammatory response. Pseudomonas aeruginosa is an opportunistic organism that spreads from reservoirs to immunocompromised patients, most frequently via the hands of hospital personnel. Infections in acute leukaemia are often accompanied by fatal septicaemia and pneumonia.^2,3 A few of these complications may result in long and lasting residual disability. Organ necrosis following treatment has rarely been described. Two of our patients developed gangrene and necrosis of the nose and nasal septum and one patient acquired necrosis of the nose and the labia minora. In all patients Pseudomomas aeruginosa infection was isolated bacteriologically and resulted in subsequent tissue loss.