8 MONTHS OLD MALE WITH ERYSIPELAS

Supervised byNugrohoadji Dharmawan, dr., Sp.KK, M.Kes

Faris Khairuddin SyahG99141114

INTRODUCTION

Erysipelas

•Infection involving superficial dermal structures•Erysipelas was known as St. Anthony’s Fire•Distinguished with cellulitis by well demarcated raised borders

Erythematous patch

•Tenderness•Edematous•Indurated•Shiny•Well-defined•Well-demarcated

The Infectious Disease Society of America (IDSA)

•Streptococcus pyogenes•Group B Streptococcus•Group C Streptococcus•Group G Streptococcus

ETIOLOGY

Streptococcus is the most common etiology of erysipelas

• Group A Streptococcus

Face

• Non-Group A Streptococcus

Lower extremity

Toxemia rather than bacteremia

Port d’ entry becomes bacterial inoculation site

EPIDEMIOLOGY

Lower incidence

• Antibiotic era• Growing sanitary• Lower virulence

Face Lower Extremities

No race dependencies

Adult Female > Adult Male

Male Children > Female Children

Highest rate on 60-80

aged

PATHOGENESIS

Port d’ entry

Bacteria

Tissue

• Polysacaride wall• Fibrin barrier• Cell membrane Trauma Anaerobic bacteria

Low count organism Cytokine reaction and bacteria superantigen

CLINICAL MANIFESTATIONProdrome of fever, chills, and general malaise on incubation period

Fever

Pain and tenderness on port d’ entry Small erythematous patch

• Bright red• Edematous• Indurated• Shiny• Well-defined• Slightly raised borders• Well-demarcated

Bulging dan tenderness regional lymphatic tissue

CLINICAL MANIFESTATION

Adult•Lower extremity•Interdigitalis regional•Hand•Trunk•Face

Children •Face•Extremities

CLINICAL EXAMINATIONPHYSICAL EXAMINATION

Prodrome of fever, chills, and general malaise on incubation

period

Fever

Pain and tenderness on port d’ entry Small erythematous patch• Bright red• Edematous• Indurated• Shiny• Well-defined• Slightly raised

borders• Well-demarcated

Bulging dan tenderness

regional lymphatic

tissue

IMAGING AND LABORATORY EXAMINATION

Blood count Leucocytosis

Biopsy Bacteria Culture

Blood Culture Suspect on sepsis

MRI

CT

CLINICAL MANIFESTATION

DIFFERENTIAL DIAGNOSIS

Insect bite

Cellulits

Ecthyma gangrenosum

Allergic Contact Dermatitis

Urtikaria

Erysipeloyd

Herpes

Zooster

Necrotizing

Fascitis

TREATMENT

DRUGS

Antibiotics (5-14 days)

• Penicillin• Cephalosphorin• Macrolide

Analgetics

• Corticosteroid Prednisone• AINS Ibuprofen

Hygiene Betadine or Hibiclens wash

Wound management

Elevation

Inpatient treatment indicated for children or immunocompromised

COMPLICATION AND PROGNOSIS

Further infection

Heart valve bacteria inoculation

Erysipelas recurrent

Permanent lymphedema

PATIENT STATUS

Identity

• Name : An. KBP• Sex : Male• Age : 8 mo• Religion: Islam• Occupation : -• Address: Kalijambe, Sragen• Status : Single• MR : 01 28 82 91

RECENT MEDICAL HISTORY

Patient came to the hospital accompanied by his mother with a chief complaint swelling in his right hand and right leg since two weeks before the examination.

The patient was referred by pediatric department.

Complained swelling in his right hand and right leg two weeks before the examination after an IV needle insertion while being treated in hospital Assalam Sragen with complaints of high fever and was diagnosed with dengue fever.

Swelling has been treated with ointment and compress (no drugs information).

Complaint was slightly reduced but the pain and heat still disturbing.

MEDICAL HISTORY

Similar disease history : (-)

Drug allergy : (-)

Food allergy : (-)

Atopic history : (-)

Inpatient history : dengue fever on Februari 2015

FAMILY MEDICAL HISTORY

Similar disease history

: (-)

Drug allergy

: (-)

Food allergy

: (-)

Atopic history

: (-)

PHYSICAL EXAMINATION

General Examination

• Compos mentis• GCS : E4V5M6• Height : 70 cm• Weight : 10 kg

Dermatological Examination

• Erythematous plaque, well-bordered and brown crust were observed on regio cruris dextra and manus dextra

LABORATORY EXAMNIATION

Antibiotic sensitivity culture

DIAGNOSIS

WORKING DIAGNOSIS

Erysipelas

DIFFERENTIAL DIAGNOSIS

Cellulitis

Deep Vein Thrombosis

TREATMENT

DrugsErytromycin syrup

Mupirocin cream

Elevation

Compress

PROGNOSIS

Ad vitam : bonam

Ad Sanam : bonam

Ad Fungsionam : bonam

Ad kosmetikum : bonam

TERIMAKASIH

Click icon to add picture