Sinonasal ecthyma gangrenosum

Sinonasal ecthyma gangrenosum. Problems/objectives: Ecthyma gangrenosum, formerly known as pyogenic gangrenosum, is a rare skin infection caused by Pseudomonas aeruginosa. The infection mostly affects patients that are immunocompromised. Few previous studies have described ecthyma gangrenosum in the sinonasal tract. Methodology: A 56-year-old woman that was immunodepressed was admitted to the Hospital Clinic of Barcelona with acute rhinosinusitis symptoms. Imaging showed signs of invasive infection at the level of the left maxillary sinus. Functional endoscopic sinus surgery was performed to debride the lesion until viable tissue was visible in the pterygopalatine and infratemporal fossa. Results: Microbiological analysis revealed the presence of multiresistant P. aeruginosa. Pathological anatomy studies pointed to extensive tissue necrosis and ruled out the presence of mycotic structures. The patient was treated with topical and intravenous colistin and meropenem, based on the antibiogram, with rapid improvement. Conclusions: It is important to consider ecthyma gangrenosum in the differential diagnosis of sinonasal necrotizing lesions.