We present a patient developing bullous erysipelas following trauma.
A 36 years old Indian gentleman presented to our emergency department with the chief complaint of reddish wound over the right shin and fever after history of abrasion wound following alleged history of fall from his motorcycle 1 week earlier. He came to our centre prior to this presentation then whereupon where antitetanus injection was given, wound irrigation and dressing was done, with and later discharged. For this current consultation, Hence, a diagnosis of infected wound was made. Dressing was done and patient was discharged with paracetamol and cloxacillin 500mg tds as the skin did not look too bad. The fever resolved after 3 days. On Day 14 post-trauma, patient returned to our follow-up clinic after noticing that the wound became more extensive involving most of anterior shin. The area was erythematous and thickened with multiple bullae. In view of the worsening of the wound, referral was made to dermatology team. Patient was diagnosed as having bullous erysipelas. He was treated as out patient by the dermatology team with oral antibiotics and cream. He came back for given appointment after 7 days at the dermatology clinic and the wound was healing well.
Bullous erysipelas, is a clinical diagnosis that indicates superficial cellulitis with lymphatic involvement; it is typically caused by group A β- hemolytic streptococci. It typically appears on the legs and face as sharply demarcated, tender erythema and edema, with an indurated border. Diagnosis involves the differential exclusion of cellulitis, allergic contact dermatitis, bullous pemphigoid, necrotizing fasciitis and varicella– zoster. Management of bullous erysipelas includes appropriate empiric antibiotic therapy, with consideration given to local rates of MRSA.
LESSONS LEARNT & CONCLUSION
Be aware that simple abrasion wound following trauma in some cases may develop bullous erysipelas as a complication. Late initiation of antibiotics may predispose this. A prolonged course of antibiotics is required for this condition because of risk of re infection and the recovery takes longer time.