A patient from Himachal Pradesh presents with fever from 5 days, altered sensorium increased JPV, maculo-papular rash & erythima on back with black necrotic tissue. Treatment includes-

Ecthyma gangrenosum is a cutaneous infection most commonly associated with Pseudomonas bacteraemia. Ecthyma gangrenosum usually occurs in patients who are critically ill and immunocompromised. The characteristic lesions of ecthyma gangrenosum are haemorrhagic (bloody) pustules that evolve into necrotic (black) ulcers The initial lesions of ecthyma gangrenosum appear as painless, round, red patches in the skin which rapidly become pustular with surrounding redness. A haemorrhagic focus appears in the centre, forming a blister. As the haemorrhagic blister spreads peripherally, it evolves into a gangrenous ulcer with a black/gray scab surrounded by a red halo. An early lesion may transform into a necrotic ulcer in as little as 12 hours. Ecthyma gangrenosum may appear at any site but mainly affects the anogenital area and armpits. The arms and legs, trunk and face are less often involved The presence of ecthyma gangrenosum should ale the physician to the likelihood of an accompanying Pseudomonas septicaemia. While awaiting culture results, piperacillin is usually given in combination with an aminoglycoside Ref Harrison20th edition pg 1078