Erysipelas

dok_zlo — 31.10.2024

A 44-year-old man with Crohn’s disease that was being treated with infliximab presented to the primary care clinic with a 2-day history of a rash on his face. In the week before presentation, his daughter had had a sore throat and his mother had had a similar rash on her face. His heart rate was 96 beats per minute, and his temperature was 36.6°C (97.9°F). Physical examination was notable for well-demarcated, warm, erythematous, confluent plaques across the cheeks, nose, and glabella, with a dimpled (peau d’orange) appearance of the skin. The pharynx was normal, and no cervical lymphadenopathy was observed. A diagnosis of erysipelas — a skin infection that involves the upper dermis — was made. Erysipelas typically manifests as a bright-red rash — often on the malar region of the face — with raised, distinct borders. Most cases can be managed with oral antibacterial agents in the outpatient setting. Blood cultures, which are not usually required for this diagnosis, were obtained in this case owing to the patient’s immunosuppression. The blood cultures grew Streptococcus pyogenes, so the patient was admitted to the hospital. Treatment was changed from oral cephalexin to a 2-week course of intravenous penicillin G potassium. After 5 days of antibacterial therapy, the patient’s rash resolved.

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