Silver-sulfadiazine eschar pigmentation mimics invasive wound infection: a case report

• Published in: Journal of burn care & rehabilitation Vol. 24; no. 3; p. 154
• Main Authors: Eldad, A, Icekson, M, Zur, T, Slosser, D, Maly, A, Arielli, D, Burvin, R, Ad-El, D, Neuman, A
• Format: Journal Article
• Language: English
• Published: United States 01.05.2003
• Subjects: Anti-Infective Agents, Local - administration & dosage; Anti-Infective Agents, Local - adverse effects; Burkholderia cepacia - isolation & purification; Burns - drug therapy; Burns - microbiology; Candida tropicalis - isolation & purification; Candidiasis - drug therapy; Candidiasis - prevention & control; Child, Preschool; Cicatrix - etiology; Cicatrix - pathology; Diagnosis, Differential; Escherichia coli - isolation & purification; Female; Gram-Negative Bacterial Infections - drug therapy; Gram-Negative Bacterial Infections - prevention & control; Humans; Pigmentation Disorders - chemically induced; Pigmentation Disorders - diagnosis; Pigmentation Disorders - pathology; Pseudomonas aeruginosa - isolation & purification; Silver Sulfadiazine - administration & dosage; Silver Sulfadiazine - adverse effects; Time Factors; Treatment Outcome; Wound Infection - diagnosis; Wound Infection - microbiology
• ISSN: 0273-8481
• DOI: 10.1097/01.BCR.0000069440.78932.70

A 3-year-old girl with 52% TBSA scalds, mostly partial thickness, was treated topically with 5% mafenide acetate solution and 1% silver sulfadiazine cream. All blood cultures and wound swabs were negative for the first 5 days. On day 6 gram-negative bacteria and yeast forms were isolated from her wounds. High fever and leukocytosis were present and the child was treated with intravenous ampicillin and gentamicin according to sensitivity bacteriogram. The bacteria were identified as Pseudomonas aeruginosa and the yeast was Candida tropicalis. On day 7, Escherichia coli was identified in blood cultures and intravenous cefixime was added. Amphotericin B was added on day 9 when blood cultures grew Candida tropicalis and Burkholderia cepacia. On day 13 dark pigmentation foci developed on some areas of partial-thickness burns in the back, resembling invasive wound infection. White blood cell count was 14,300 cells/mm3, and her body temperature reached 39.7 degrees C. Cultures from the pigmented areas were negative, and biopsies revealed deposits of silver. Most of the areas healed uneventfully, and only about 8% TBSA needed grafting, including some of the pigmented areas. No residual pigmentation remained on discharge.