Erysipeloid cutaneous leishmaniasis: a study of 40 cases of an unusual variant.

BACKGROUND: Erysipeloid cutaneous leishmaniasis (ECL) is known as the chronic form of cutaneous leishmaniasis (CL). However, keeping its clinical presentation in view, there is a need to revisit this form of the disease. AIMS: To describe ECL in view of clinical features and treatment modalities. METHODS: We include a case series seen in Sfax (Southern Tunisia) from January 2017 to January 2021. All patients clinically suggestive and laboratory confirmed with a diagnosis of CL were registered. Patients of all age groups and of either gender having cutaneous lesions resembling erysipela on the face were included in the study. Different demographic features of the patients and clinical aspects were identified. Descriptive statistics were used for analysis. RESULTS: Of 1300 registered patients with CL, 40 (3%) were diagnosed as ECL. Ages ranged from 15 to 65 years, and duration of lesions varied from 15 to 180 days. All patients had lesions over the face. Clinically, a painful infiltrated inflammatory placard of the central facial area with a butterfly shape was observed in 14 cases, as well as zones of the cheekbone (11 cases), cheekbone and nose (5 cases), cheekbone and eyelid (8 cases), and cheekbone with ear (2 cases). Several therapeutic methods were prescribed with a sufficient result with no recurrence. CONCLUSION: ECL is a rare presentation that typically occurs on the face, looking like erysipelas, in patients who are native from an endemic region of CL.

Erysipeloid lesions caused by Erysipelothrix rhusiopathiae in a dog: clinical and histopathological findings, molecular diagnosis and treatment.

BACKGROUND: Erysipelothrix rhusiopathiae is a widespread Gram-positive, nonsporulating rod bacterium predominantly associated with skin disease in swine and cetaceans. Cutaneous lesions have yet to be described in dogs. OBJECTIVE: To describe the clinical presentation, molecular and histopathological diagnosis, and treatment of a case of erysipeloid caused by E. rhusiopathiae in a dog. ANIMALS: A 6-month-old spayed female standard poodle dog presented with lethargy, fever, vomiting and diarrhoea. Skin lesions appeared 20 days post first examination. METHODS AND MATERIALS: Complete blood count, serum chemistry profile, urinalysis, urine culture, blood culture, computed topography, forelimb radiography, joint and cerebrospinal fluid aspiration were performed; samples were collected for skin cytological evaluation, culture and histopathological analysis. RESULTS: Blood cultures yielded Gram-positive, catalase-negative bacilli. Histopathological evaluation of skin biopsies revealed lymphoplasmacytic, neutrophilic and histiocytic perivascular and periadnexal dermatitis, and vasculitis. Cutaneous and blood PCR and sequencing of 16S rRNA identified the bacteria as E. rhusiopathiae. Clinical resolution was observed following the use of of amoxicillin/clavulanic acid and ciprofloxacin therapies. CONCLUSIONS AND CLINICAL IMPORTANCE: To the best of the authors' knowledge, this is the first confirmed case of erysipeloid caused by E. rhusiopathiae in a dog. Clinical resolution was attained with the extended use of antibiotics. After 13 months, no clinical signs had returned.

Erysipelatoid Carcinoma.

Erysipelatoid Carcinoma (EC), also known as Inflammatory Metastatic Carcinoma, is a rare form of cutaneous metastasis, secondary to an internal malignancy, more often related to breast cancer. Clinically, the lesion has a well-marked, bound erythematous appearance, much like an infectious process, such as erysipelas and cellulitis, these being the most common differential diagnoses. It is characterized by an acute or subacute appearance with an erythematous plaque, sometimes hot and painful, being more often situated in the primary tumor vicinity, especially in the thorax wall in the region of a mastectomy due to breast cancer. Here we present the case of a 75-year-old patient with ductal infiltrated carcinoma for 3 years, who presented an acute erythematous and infiltrated plaque in the region of a previous mastectomy, with a final diagnosis of EC.

Erysipelatoid Carcinoma

SUMMARY Erysipelatoid Carcinoma (EC), also known as Inflammatory Metastatic Carcinoma, is a rare form of cutaneous metastasis, secondary to an internal malignancy, more often related to breast cancer. Clinically, the lesion has a well-marked, bound erythematous appearance, much like an infectious process, such as erysipelas and cellulitis, these being the most common differential diagnoses. It is characterized by an acute or subacute appearance with an erythematous plaque, sometimes hot and painful, being more often situated in the primary tumor vicinity, especially in the thorax wall in the region of a mastectomy due to breast cancer. Here we present the case of a 75-year-old patient with ductal infiltrated carcinoma for 3 years, who presented an acute erythematous and infiltrated plaque in the region of a previous mastectomy, with a final diagnosis of EC.

Erysipeloid rash: A rare adverse event induced by gemcitabine.

Some rare cases of erysipelas-like or pseudocellulitis have been reported in relation to gemcitabine. This rare adverse event is more frequent in the presence of edema. Here, we report a case of pseudocellulitis after adjuvant treatment for pancreatic cancer. Oncologists should be aware of this infrequent and non-well understood adverse event. They should be especially careful when administering gemcitabine in the presence of lymphedema.

A case of apparent canine erysipeloid associated with Erysipelothrix rhusiopathiae bacteraemia.

BACKGROUND: Erysipelothrix rhusiopathiae is a Gram-positive facultative anaerobe found worldwide and is most commonly associated with skin disease in swine, while anecdotal reports of cases in dogs have been associated with endocarditis. HYPOTHESIS/OBJECTIVES: Clinicians should consider systemic infectious diseases as a potential cause of erythematous skin lesions. ANIMALS: A 5-year-old female spayed Labrador retriever presented with lethargy, anorexia and erythematous skin lesions while receiving immunosuppressive therapy for immune-mediated haemolytic anaemia. Four days prior to presentation, the dog had chewed on a raw turkey carcase. METHODS: Complete blood count, serum chemistry profile, urinalysis and blood cultures. RESULTS: Blood cultures yielded a pure growth of E. rhusiopathiae serotype 1b. Amoxicillin 22 mg/kg orally twice daily for 2 weeks and discontinuation of azathioprine resulted in remission of fever and skin lesions. CONCLUSIONS AND CLINICAL IMPORTANCE: This report is the first documentation, to the best of the authors' knowledge, of Erysipelothrix infection, a known zoonosis, in an immunosuppressed dog, highlighting the need for infectious disease monitoring in patients receiving such therapy. This information may also help educate veterinarians to include Erysipelothrix infection as a differential diagnosis in dogs with fever and skin lesions, as well as the role of blood cultures in diagnosing this disease.

Unusual form of cutaneous leishmaniasis: erysipeloid form.

UNLABELLED: We report the epidemiological and clinical characteristics of the erysipeloid form of cutaneous leishmaniasis as well as its diagnostic and therapeutic challenges. CASE REPORT: A 63-year-old woman, with no medical history, presented with a one-month history of erythematous nasal swelling. The lesion appeared after an accidental trauma. Erythematous infiltrative plaque was noted on the center of the face. There were also crust formations on the traumatic region. Despite local treatment and oral antibiotherapy, there was no improvement. The diagnosis of cutaneous leishmaniasis was confirmed by positive skin smears. Histopathological examinations of a skin biopsy showed no malignancy. The patient was treated intramuscularly with 10mg/kg per day systemic meglumine antimoniate with partial regression of symptoms. CONCLUSION: The erysipeloid type is a rare and unusual presentation of cutaneous leishmaniasis that often causes late diagnosis. Diagnosis is confirmed by the demonstration of the parasite by skin smear, histopathological examination and polymerase chain reaction. There are various therapeutic options. The evolution is generally favourable.

Erysipeloid: a review.

Erysipeloid is an occupational infection of the skin caused by traumatic penetration of Erysipelothrix rhusiopathiae. The disease is characterized clinically by an erythematous oedema, with well-defined and raised borders, usually localized to the back of one hand and/or fingers. Vesicular, bullous and erosive lesions may also be present. The lesion may be asymptomatic or accompanied by mild pruritus, pain and fever. In addition to cutaneous infection, E. rhusiopathiae can cause endocarditis, which may be acute or subacute. Endocarditis is rare and has a male predilection. It usually occurs in previously damaged valves, predominantly the aortic valve. Endocarditis does not occur in patients with valvular prostheses and is not associated with intravenous drug misuse. Diagnosis of localized erysipeloid is based on the patient's history (occupation, previous traumatic contact with infected animals or their meat) and clinical picture (typical skin lesions, lack of severe systemic features, slight laboratory abnormalities and rapid remission after treatment with penicillin or cephalosporin).

Erysipeloid leishmaniasis: an unusual clinical presentation.

Old World cutaneous leishmaniasis has many different clinical presentations. A rare and unusual presentation of cutaneous leishmaniasis is the erysipeloid type. This clinical form is not only unusual in its clinical features but also in the specific category of patients it seems to afflict. In this report 5 Iranian patients, predominantly females, between 50 and 70 years of age, presented with infiltrative erythematous lesions covering the center of the face and resembling erysipelas. Skin smears and/or skin biopsies revealed the diagnosis of cutaneous leishmaniasis. The reason for this type of presentation is unclear, although factors such as the specific species involved, the host's immune response, the hormonal changes encountered with increasing age, and the changes in skin barrier with ageing can be speculated as being important points in causing such an unusual presentation.

Erysipelas in caged laying chickens and suspected erysipeloid in animal caretakers.

Erysipelas was diagnosed in 2 succeeding caged layer flocks housed in the same building and was characterized clinically by sudden death. At necropsy, lesions comprised generalized congestion, hemorrhages in the skeletal muscles and visceral organs, and swelling of liver, spleen, and kidney with or without large irregular zones of necrosis. Focal to massive hepatic necrosis was seen histologically with minimal or no inflammatory reaction. Erysipelothrix rhusiopathiae was cultured from internal organs of affected birds in both outbreaks. Medication with penicillin in the feed controlled the mortality, but relapse occurred after cessation of medication. Two attendants who handled the dead birds in this building developed a painful localized infection of the fingers that later spread to the regional lymph node. The infection responded when antibiotic therapy for erysipeloid was initiated.

Erysipelothrix rhusiopathiae: an occupational pathogen.

Erysipelothrix rhusiopathiae is a nonsporulating, gram-positive, rod-shaped bacterium which was identified more than 100 years ago as the etiologic agent of swine erysipelas. Since then, it has been found to cause infection in several dozen species of mammals and other animals. Humans become infected through exposure to infected or contaminated animals or animal products. By far the most common type of human infection is a localized, self-limited cutaneous lesion, erysipeloid. Diffuse cutaneous and systemic infections occur rarely. Approximately 50 cases of endocarditis have been reported; all but one recent case have involved native valves. The organism may be isolated from biopsy or blood specimens on standard culture media. It is identified by morphology, lack of motility, and biochemical characteristics; identification may be confirmed by the mouse protection test. It is susceptible to penicillins, cephalosporins, erythromycin, and clindamycin, but it is often resistant to many other antibiotics, including vancomycin, a drug frequently used in empiric therapy for infections due to gram-positive bacteria.