Life Threatening Complication during Treatment of Erysipelas due to Undiagnosed Ischemia of the Calf

Abstract

Erysipelas is a superficial skin infection due to streptococci strains, which usually responds well to conservative treatment. Coexisting undiagnosed ischemia of the extremity may lead to severe complications. 57-year-old man developed large, circumflex ulceration of his right calf within two weeks before the admission after three-month treatment of erysipelas. Computer angiography showed chronic occlusion of the superficial femoral artery and the above knee popliteal artery. Rapid debridement of the wound took control over the infection. Patient required complex vascular procedure which allowed to prepare the ulcer for meshed skin grafts. Patient was discharged home on 64th hospital day with completely healed ulcer.

Figure 1

The view of the calf one week after the debridement: granulation is clearly visible with shrinking of the ulceration and remaining necrosis of the skin.

Figure 2

Computer angiography presenting arteries of the right lower extremity. An arrow shows the bifurcation of femoral artery and occlusion of superficial femoral one. Deep femoral artery is well developed. Common iliac artery and external iliac one seem to be normal.

Figure 3

The view of the calf at the end of the treatment. Skin grafts nearly completely healed. Postoperative wound also healed, visible above the knee.