Wrong diagnosis erysipelas: hypodermitis - case series and review of literature.

Background: Patients with an advanced chronic venous insufficiency (CVI) often show inflammatory changes of their legs. Often erysipelas is diagnosed and systemic antibiotic therapy initiated. Frequently this approach is not successful.

Patients And Methods: During the last 6 months 5 patients with an outside diagnosis of erysipelas presented to our clinic. All had a painful erythema of the medial part of one or both calves and all failed numerous antibiotic regimens.

Results: In all patients a sharply demarcated, tender indurated erythema of the medial part of one or both calves was seen. Inguinal lymphadenopathy, fever and other systemic signs and symptoms were absent. In 4 of 5 patients normal laboratory inflammatory parameters were normal. We diagnosed hypodermitis in all. They were treated with compression therapy and topical corticosteroids. In addition, their underlying CVI was addressed.

Conclusions: Dermatosclerosis is often seen in patients with advanced CVI. An acute inflammatory phase (hypodermitis) and a chronic phase of the disease can be differentiated. The acute hypodermitis can imitate erysipelas clinically, with systemic signs and symptoms, as well as laboratory evidence of inflammation generally being absent.