Erysipeloid Clinical Presentation

Updated: Apr 18, 2017
  • Author: Marc Zachary Handler, MD; Chief Editor: Dirk M Elston, MD  more...
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Presentation

History

Erysipeloid may present in humans as one of three clinical forms.

  • Localized cutaneous form (also known as erysipeloid of Rosenbach); vesicles or bullae may develop [7]

  • Diffuse cutaneous form

  • Generalized or systemic infection as evidenced by bacteremia: Endocarditis may or may not develop. [8]

In the first two forms of erysipeloid, patients may be asymptomatic or present with local burning, pruritus, or pain at lesion sites. They may or may not have fever, malaise, and other constitutional symptoms.

In the generalized form, patients present with fever, chills, weight loss, and a variety of other symptoms (eg, joint pain, cough, headache), depending on the organ system involved.

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Physical Examination

Localized form of erysipeloid

Lesions most commonly affect the back of the hands, mainly the webs of the fingers; however, any exposed area of the body may be affected. Lesions consist of well-demarcated, bright red-to-purple plaques with a smooth, shiny surface. Lesions are warm and tender and spread in a centrifugal manner. They leave a brownish discoloration on the skin when resolving. Sometimes vesicles may be present. [9]  See the images below. 

Erysipeloid. Courtesy of DermNet New Zealand (http Erysipeloid. Courtesy of DermNet New Zealand (http://www.dermnetnz.org/topics/erysipeloid/) and the Waikato District Health Board (http://www.waikatodhb.health.nz/).
Erysipeloid. Courtesy of DermNet New Zealand (http Erysipeloid. Courtesy of DermNet New Zealand (http://www.dermnetnz.org/topics/erysipeloid/) and the Waikato District Health Board (http://www.waikatodhb.health.nz/).

Diffuse cutaneous form of erysipeloid

Multiple lesions appear on various parts of the body. Lesions are well-demarcated, violaceous plaques with an advancing border and central clearing. Patients commonly have systemic symptoms such as fever, malaise, and arthralgias. Blood cultures are negative. [10]

Systemic form of erysipeloid

Also referred to as septic erysipeloid, skin lesions may not be apparent in this form. If present, skin lesions appear as localized areas of swelling surrounding a necrotic center. Skin lesions also may present as several follicular, erythematous papules. Endocarditis is the most common, but still rare, manifestation of systemic erysipeloid. [11] Hepatic failure, renal failure, cerebral infarcts, osseous necrosis, meningitis, encephalitis, and arthritis have been reported. [10]

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Causes

Erysipelothrix rhusiopathiae causes all three forms of erysipeloid. E rhusiopathiae is a thin, gram-positive bacillus that may be straight or slightly curved. The microorganism is present in the soil and in poultry, fish, and birds. Homemakers, farmers, anglers, and butchers are at increased risk of acquiring the infection. Injection comes from a prior wound being contaminated with the bacteria.

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Complications

Complications may include the following:

  • Permanent neurological damage (eg, cerebrovascular accident)

  • Endocarditis with long-term valvular heart disease

  • Septic arthritis with long-term joint diseases

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