INTRODUCTION
Ecthyma gangrenosum (EG) is a relatively uncommon cutaneous infection that mostly occurs in individuals with immunosuppression due to different underlying diseases including hematologic disorders, malignancies, lymphoproliferative disorders and autoimmune diseases. However, it has also been reported among previously healthy individuals1-4, both adults and children.Pseudomonas aeruginosa  is the most common cause of EG, with or without bacteremia, although it is also known to be caused by a variety of pathogens, including different bacteria, fungi and viruses1. Lesions first appear as painless papules which rapidly evolve in gangrenous ulcers. The macroscopic appearance corresponds to the microvascular thrombosis and subsequent dermal ischemic necrosis5. Single or multiple lesions might involve one or more sites in the body, mainly the axillary and perineal regions. Prompt recognition and timely adequate treatment are crucial for the prognosis1.
In patients with hematological malignancies and cancer, many factors (immunosuppression, mucositis and epithelial damage, microbiome dysbiosis and prolonged use of central venous devices) predispose to bacterial infections, usually affecting integumental surfaces such as respiratory tract, gastrointestinal tract and skin. The frequently atypical clinical presentation of these infections makes the prompt recognition often challenging6.
There are scant reports describing the occurrence of EG in onco-hematological patients, mainly as case reports or small case series7-16. We report the results of a large multicenter pediatric retrospective collection of 38 cases of proven EG diagnosed between 2009 and 2019 in children with hematological disease and cancer. The aim is to describe the clinical picture and characteristics of EG, to early recognize and diagnose it, since timely treatment influences the outcome of this infection. In fact, particularly in this setting of patients, prompt interventions may change the course of both this serious infection and the underlying disease. The wide spectrum of clinical pictures at different levels of severity in our sample allowed a more complete evaluation of EG infection at different stages, considering that cases reported in the literature have mainly a devastating clinical presentation.