eMedicine Specialties > Emergency Medicine > Infectious Diseases

Erysipelas: Differential Diagnoses & Workup

Author: Geofrey Nochimson, MD, Consulting Staff, Department of Emergency Medicine, Sentara Careplex Hospital
Contributor Information and Disclosures

Updated: Sep 24, 2008

Differential Diagnoses

Angioedema
Systemic Lupus Erythematosus
Cellulitis
Urticaria
Dermatitis, Contact
Herpes Zoster
Necrotizing Fasciitis

Other Problems to Be Considered

Angioneurotic edema
Dermatophytid
Erysipeloid
Polychondritis
Scarlet fever
Tuberculoid leprosy

Workup

Laboratory Studies

  • In general, diagnosis of erysipelas is made clinically. Few laboratory tests are of help in the ED.
  • Complete blood count (CBC): Increased WBC with a leftward shift may be observed but is not specific for the diagnosis.
  • Blood cultures
    • Positive in only 5% of cases
    • May be helpful when a question of the diagnosis or concern about bacteremia with metastatic infection exists
    • May be of some benefit in patients with prosthetic heart valves or other intravascular devices, artificial joints, or in the immunocompromised or toxic-appearing patient
    • Gram stain and culture of rash generally not helpful
  • Antistreptolysin (ASO), streptozyme, and anti-DNAase titers may be helpful.

More on Erysipelas

Overview: Erysipelas
Differential Diagnoses & Workup: Erysipelas
Treatment & Medication: Erysipelas
Follow-up: Erysipelas
References

References

  1. Bisno AL, Stevens DL. Streptococcal infections of skin and soft tissues. N Engl J Med. Jan 25 1996;334(4):240-5. [Medline].

  2. Bonnetblanc JM, Bedane C. Erysipelas: recognition and management. Am J Clin Dermatol. 2003;4(3):157-63. [Medline].

  3. Bratton RL, Nesse RE. St. Anthony's Fire: diagnosis and management of erysipelas. Am Fam Physician. Feb 1 1995;51(2):401-4. [Medline].

  4. Chartier C, Grosshans E. Erysipelas. Int J Dermatol. Sep 1990;29(7):459-67. [Medline].

  5. Elston DM. Epidemiology and prevention of skin and soft tissue infections. Cutis. May 2004;73(5 Suppl):3-7. [Medline].

  6. Jorup-Ronstrom C, Britton S. Recurrent erysipelas: predisposing factors and costs of prophylaxis. Infection. Mar-Apr 1987;15(2):105-6. [Medline].

  7. Krasagakis K, Samonis G, Maniatakis P, Georgala S, Tosca A. Bullous erysipelas: clinical presentation, staphylococcal involvement and methicillin resistance. Dermatology. 2006;212(1):31-5. [Medline].

  8. Swartz MN. Erysipelas. In: Mandell GL, ed, et al. Principles and Practice of Infectious Diseases. 4th ed. Churchill Livingstone; 1995:913-14.

  9. Torok L. Uncommon manifestations of erysipelas. Clin Dermatol. Sep-Oct 2005;23(5):515-8. [Medline].

  10. Lopez FA, Lartchenko S. Skin and soft tissue infections. Infect Dis Clin North Am. Dec 2006;20(4):759-72, v-vi. [Medline].

  11. Morris A. Cellulitis and erysipelas. Clin Evid. Jun 2006;2207-11. [Medline].

Further Reading

Keywords

erysipelas, group A beta-hemolytic streptococci, hemolytic streptococcus, skin infection, painful rash, erythematous rash, edematous rash, abrasions, skin ulcers, insect bites, eczema, psoriatic lesions, lymphatic obstruction, lymphatic edema, saphenous vein grafting in lower extremities, postradical mastectomy, immunocompromised patients, diabetes, alcoholism, arteriovenous insufficiency, paretic limbs

Contributor Information and Disclosures

Author

Geofrey Nochimson, MD, Consulting Staff, Department of Emergency Medicine, Sentara Careplex Hospital
Geofrey Nochimson, MD is a member of the following medical societies: American College of Emergency Physicians
Disclosure: Nothing to disclose.

Medical Editor

Francis Counselman, MD, Program Director, Chair, Professor, Department of Emergency Medicine, Eastern Virginia Medical School
Francis Counselman, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Emergency Physicians, Norfolk Academy of Medicine, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Eddy Lang, MDCM, CCFP (EM), CSPQ, Assistant Professor, Department of Family Medicine, McGill University; Consulting Staff, Department of Emergency Medicine, The Sir Mortimer B Davis-Jewish General Hospital
Eddy Lang, MDCM, CCFP (EM), CSPQ is a member of the following medical societies: American College of Emergency Physicians
Disclosure: Nothing to disclose.

CME Editor

John D Halamka, MD, MS, Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center
John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Chief Editor

Jonathan Adler, MD, Attending Physician, Department of Emergency Medicine, Massachusetts General Hospital; Division of Emergency Medicine, Harvard Medical School
Jonathan Adler, MD is a member of the following medical societies: American Academy of Emergency Medicine and Society for Academic Emergency Medicine
Disclosure: eMedicine.com, Inc. Consulting fee Consulting

 
 
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