Ecthyma amidst the global monkeypox outbreak: A key differential? -A case series.

Background: Ecthyma is a deeper form of impetigo involving the epidermis and dermis causing ulcerative plaques. Pathogens commonly responsible for the disease (group A beta-hemolytic streptococcus and Staphylococcus aureus) typically afflicts children, presenting during early stages with skin lesions that can closely resemble other vesicular and ulcerative dermatoses, such as those observed in mpox infection. The ongoing global outbreak of monkeypox has escalated the urgency for clinicians to accurately differentiate between these conditions due to their overlapping dermatological manifestations. Through this series, we intend to demonstrate the diverse clinical presentations of ecthyma observed in non-endemic regions, which may closely mimic those of monkeypox.

Case presentation: The first case describes a 12- year-old male with a history of atopic dermatitis, presenting with a vesicular rash initially suspected to be monkeypox. However, diagnosis via skin punch biopsy and cultures revealed ecthyma. The second case involved an 18-year-old male with acute, rapidly progressing ulcerated lesions and systemic symptoms. Differential diagnosis included toxic shock syndrome and necrotizing fasciitis, but histopathological findings confirmed ecthyma. The third case featured a 55-year-old woman with rapidly developing skin lesions on her hand, resolved through empirical antibiotic therapy, further confirming the diagnosis.

Conclusion: misdiagnosis and thus, delayed treatment of ecthyma leads to severe unfavourable outcomes. Given its rare occurrence yet fatal potential, and the current global vigilance due to the monkeypox outbreak, it is vital for healthcare providers to include ecthyma in the differential diagnosis of necrotic and ulcerative skin lesions.