Infectious skin diseases constitute a significant public health problem. Despite the systematic development of many modern diagnostic and therapeutic tools, they still pose a serious challenge for clinicians. Due to their prevalence and mild course in most cases, they are often marginalized, which can delay their diagnosis and treatment initiation. Such an approach in more clinically advanced cases can have serious consequences, sometimes leading to tragic outcomes. This work presents a series of four cases of common infectious skin diseases with an unusually atypical clinical picture: the history of a 49-year-old female patient with recurrent erysipelas of the right lower leg co-occurring with a SARS-CoV-2 infection, a 75-year-old male patient with a generalized form of herpes zoster, a 38-year-old female patient with a complicated severe course of head lice, and a 34-year-old male patient with a severe form of post-steroid mycosis. In each of these cases, difficulties in making the correct diagnosis were highlighted, even though they represent some of the most common bacterial, viral, parasitic, and fungal dermatoses. The paper discusses the risk factors for these diseases, the pathophysiology of their atypical course, the effects and challenges in the therapeutic approach conducted. Infectious skin dermatoses require aggressive treatment and should never be underestimated.
Choroby zakaźne skóry są istotnym problemem zdrowia publicznego. Pomimo systematycznego rozwoju nowoczesnych narzędzi diagnostycznych oraz terapeutycznych stanowią poważne wyzwanie dla klinicystów. Ze względu na swoją powszechność niejednokrotnie są marginalizowane, co może opóźniać diagnozę oraz wdrożenie leczenia. Takie postępowanie w bardziej zaawansowanych klinicznie przypadkach może mieć poważne, czasem tragiczne następstwa. W pracy prezentowana jest seria czterech przypadków częstych chorób zakaźnych skóry o wyjątkowo nietypowym obrazie klinicznym: 49-letniej pacjentki z różą nawrotową podudzia prawego współwystępującej z infekcją SARS-CoV-2, 75-letniego pacjenta z uogólnioną, ciężką formą półpaśca, 38-letniej pacjentki z wszawicą głowową oraz 34-letniego pacjenta z ciężką postacią grzybicy skóry głowy owłosionej (typu „incognito”). W każdym z wymienionych przypadków zaprezentowano problemy z ustaleniem prawidłowej diagnozy, pomimo, że reprezentują one powszechnie występujące dermatozy bakteryjne, wirusowe, pasożytnicze oraz grzybicze. W pracy zostały omówione czynniki ryzyka ww. chorób, patofizjologia ich nietypowego przebiegu, efekty oraz wyzwania w przeprowadzonym postępowaniu terapeutycznym. Dermatozy zakaźne skóry wymagają intensywnego leczenia i nie powinny być nigdy bagatelizowane.

Erysipelas/cellulitis are severe skin infections that are especially dangerous for immunocompromised patients. The most common cause of these diseases is streptococcal infection, but sometimes they may be caused by other Gram-positive or negative bacteria or other factors. Proper diagnosis and treatment should be implemented accurately to prevent dangerous complications. We present a case of severe bullous erysipelas caused by Escherichia coli and discuss the diagnosis, differential diagnosis, and treatment of cellulitis in kidney transplant patients.

Early diagnosis of the spiked helmet sign is challenging. This ST-elevation myocardial infarction mimic was first described in 2011 by Littmann and colleagues and was linked to severe non-coronary pathologies, with a high risk of mortality. We present a case of a 60-year-old female patient who developed severe erysipelas with sepsis associated with severe hypokalemia. She had a spiked helmet sign on her routine electrocardiogram at hospital admission. We performed a coronary angiogram that showed no culprit artery. She developed afterward an ischemic stroke. Through intensive management of the patient\'s sepsis and electrolyte disturbance, she had a favorable outcome.

Cutaneous leishmaniasis can present in many different clinical forms. Diagnosis of atypical forms is often delayed. It is useful to keep in mind the diagnosis of cutaneous leishmaniasis, a mimicking disease, to reduce unnecessary treatment and patient morbidity. Erysipeloid leishmaniasis should be considered when presented as long-term erysipelas-like lesions that do not respond to antibiotics. We want to present our five patients with erysipeloid leishmaniasis, one of the atypical clinical forms.

Gastric cancer (GC) is the fifth most commonly diagnosed malignancy and the fourth leading cause of cancer death worldwide. Skin metastases from internal organs are rare; skin metastasis from GC occurs even more rarely than skin metastases originating from other organs, and is associated with systematic disease and poor prognosis. The present study described an interesting and rare case of an extensive skin rash in a 42-year-old man diagnosed with GC, which was mainly affecting his left hemithorax, abdomen and back. The rash masqueraded as erysipelas and was initially treated as such; however, it did not respond to antibiotics, corticosteroids and antihistamines. Due to its persistence and location, the rash was biopsied and GC metastasis was confirmed. Third-line chemotherapy was administered and the rash decreased in size; however, the patient suffered from disease deterioration with lung metastases and respiratory failure. The patient eventually died 4 months after the diagnosis of skin metastasis. In conclusion, cutaneous metastasis should be considered as a late and difficult to treat metastasis of GC, which requires high surveillance from medical oncologists, and a multidisciplinary approach for prompt and accurate diagnosis.

BACKGROUND: Bordetella trematum is unknown to most clinicians and microbiologists. However, this Gram-negative opportunistic bacterium can be responsible for ulcer superinfection but also bacteremia and sometimes death by septic shock.
METHODS: We report the case of erysipelas due to B. trematum with bacteremia in an immunocompromised 88-year-old Caucasian patient.
CONCLUSIONS: In immunocompromised patients, unusual microbial agents such as B. trematum can be responsible for cutaneous and systemic infections, requiring specific antibiotic therapy. Therefore, clinicians should be aware of the need for specific bacterial identification such as matrix-assisted laser desorption ionization time-of-flight mass spectrometry and 16S ribosomal RNA sequencing in the context of atypical evolution of erysipelas in such patients.

A 51 year old man with active follicular lymphoma presented with several days of erythematous skin nodules on all extremities two weeks after a self-limited diarrheal illness. All serum immunoglobulin levels were found to be low. Blood cultures grew Campylobacter jejuni. The patient was given one week of azithromycin with complete resolution of his skin nodules. The literature of skin manifestations seen in active Campylobacter jejuni infection are reviewed. The majority of cases occur in immunocompromised hosts, many with low or no serum immunoglobulin levels. Postulated mechanisms include a lack of secretory IgA in intestinal mucosa predisposing susceptible patients to translocated enteric pathogens however the precise pathogenesis underlying cutaneous manifestations are unknown.

OBJECTIVE: The aim of this case-control study was to identify risk factors associated with necrotizing fasciitis (NF) of the lower limbs.
METHODS: We conducted a prospective case-control study in hospital dermatology departments in 5 sub-Saharan African countries over a 2-year period (April 2017 to July 2019). The cases were patients with NF of the lower limbs and the controls were patients with leg erysipelas. Each case was matched with two controls for age (±5 years) and sex. We analyzed local and general factors.
RESULTS: During the study period, 159 cases (73 females, 86 males) were matched with 318 controls. The mean age was 48.5±15.8 years for cases and 46.5±16.2 years for controls (P=0.24). The main local signs of NF were cutaneous necrosis (83.7%), pain (75.5%) and induration (42.1%). Multivariate analysis showed the following to be independent risk factors associated with NF of the lower limbs: obesity (odds ratio [OR]=2.10; 95% confidence interval [CI]: 1.21-3.42), diabetes (OR=3.97; 95% CI: 1.95-6.13), nicotine addiction (OR=5.07; 95% CI: 2.20-11.70), use of non-steroidal anti-inflammatory drugs (NSAIDs) (OR=7.85; 95% CI 4.60-14.21) and voluntary cosmetic depigmentation (OR=2.29; 95% CI: 1.19-3.73).
CONCLUSIONS: Our study documents the role of NSAID use at the onset of symptoms as a risk factor for NF of the lower limbs. However, the originality of our study consists in the identification of voluntary cosmetic depigmentation as a risk factor for NF of the lower limbs in sub-Saharan Africa patients. Our results also identified typical overarching factors such as diabetes, obesity and nicotine addiction. Knowing these factors and taking them into account will enable optimization of management strategies for these conditions.

Erysipelas is a non-necrotizing acute dermal hypodermatitis most often of streptococcal origin. It most often affects the lower limbs. Erysipelas on surgical scar has been rarely reported in the literature. Few cases have been published since the first descriptions of this pathological entity by Baddour et al in 1982. We report the case of a 47-year-old patient. Operated for right breast mucinous carcinoma, she had neo-adjuvant chemotherapy followed by a surgical treatment (Patey) which occured without incident. The evolution was marked by the appearance after 11 months of the intervention of an Erysipelas on Patey scar. The patient was put on cefazol for 7 days intravenously injectable. The evolution was marked by the complete disappearance of the rash and the edema.

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