PMC4763578_01
Crusted and gangrenous plaque around left eye
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F1
There were multiple hemorrhagic bullae that ruptured to form a gangrenous ulcer with an overlying eschar [Figure 1].
H and E x10: Necrosis of the epidermis with necrotic exudate in the dermis
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F2
P. aeruginosa in both blood agar and MacConkey agar media. Punch skin biopsy from the margin of the ulcer stained with hematoxylin and eosin showed necrosis of the epidermis and the upper dermis, covered on the surface by necrotic exudates [Figure 2].
H and E x40: Necrotic fibroadipose tissue with predominance of polymorphonuclear neutrophils
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F3
No vasculitis was found [Figure 3].
Healed lesion after antipseudomonal antibiotic
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F4
The patient regained vision in her left eye completely at the end of treatment [Figure 4].