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ECTHYMA GANGRENOSUM IN CHILDREN WITH CANCER: DIAGNOSIS AT A GLANCE. A retrospective study form the Infection Working Group of Italian Pediatric Hematology Oncology Association.
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  • Paola Muggeo,
  • Daniele Zama,
  • Nunzia Decembrino,
  • Daniela Onofrillo,
  • Stefano Frenos,
  • Antonella Colombini,
  • Katia Perruccio,
  • Elisabetta Calore,
  • Nagua Giurici,
  • Monica Ficara,
  • Milena La Spina,
  • Rosamaria Mura,
  • Raffaela De Santis,
  • Nicola Santoro,
  • Simone Cesaro
Paola Muggeo
University of Bari

Corresponding Author:[email protected]

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Daniele Zama
Sant'Orsola-Malpighi Hospital University of Bologna
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Nunzia Decembrino
Pediatric Hematology Oncology, IRCCS Policlinico San Matteo, University of Pavia
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Daniela Onofrillo
Hospital of Pescara, Pescara, Italy
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Stefano Frenos
Azienda Ospedaliero-Universitaria Meyer, Oncoematologia Pediatrica
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Antonella Colombini
MBBM Foundation, University of Milano-Bicocca, Monza, Italy
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Katia Perruccio
Pediatric Oncology and Hematology Section
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Elisabetta Calore
Pediatric Hematology and Oncology
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Nagua Giurici
Institute for Maternal and Child Health Care IRCCS Burlo Garofolo
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Monica Ficara
lScuola di Specializzazione in Pediatria, Università degli Studi di Modena e Reggio Emilia
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Milena La Spina
Policlinico di Catania
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Rosamaria Mura
Paediatric Haematology-Oncology, Ospedale Pediatrico Microcitemico, Cagliari, Italy
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Raffaela De Santis
Unit of Pediatrics
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Nicola Santoro
Division of Paediatric Haematology-Oncology, Department of Pediatrics, Bari
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Simone Cesaro
Pediatric Hematology and Oncology Unit, Department of Pediatrics, Azienda Ospedaliera Universitaria Integrata, Verona
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Purpose. To describe ecthyma gangrenosum (EG) characteristics and complications in a large multicenter pediatric retrospective collection of children with malignancies or bone marrow failure syndromes. Methods. EG episodes diagnosed in the period 2009-2019 were identified by a retrospective review of clinical charts at centers belonging to the Italian Pediatric Hematology Oncology Association. Results. EG occurred in 38 children (male/female 16/22; median age 5.2 years) with hematological malignancy (33), allogeneic stem cell transplantation (2) or relapsed/refractory solid tumor (3). The involved sites were: perineal region (19), limbs (10), trunk (6), head and the iliac crest (3). Bacteremia was present in 22 patients. Overall, the germs isolated were Pseudomonas aeruginosa (34), Stenotrophomonas maltophilia (3) and Escherichia Coli (1); 31% of them were MDR. All patients received antibacterial treatment while surgery was performed in 24 patients (63.1%). Predisposing underlying conditions for EG were: severe neutropenia (97.3%), corticosteroid treatment (71%), iatrogenic diabetes (23.7%). All patients recovered, but EG recurred in 5 patients. Nine patients (24%) showed sequelae (deep scars, with muscle atrophy in 2). Four patients (10.5%) died, 1 due to relapse of EG with KPC co-infection, 3 due to the underlying disease. Conclusions. EG requires early recognition and a proper and timely treatment to obtain the recovery and to avoid larger necrotic evolution. The occurrence of scarring sequelae might affect the quality of life of patients.