Masmoudi A, Maaloul I, Turki H, Elloumi Y, Marrekchi S, Bouassida S, Ben Jemaa M, Zahaf A
Department of Dermatology, Hedi Chaker Hospital, Sfax, Tunisia.
Dermatol Online J. 2005 Dec 1;11(3):12.
Erysipelas is a bacterial hypodermal cellulitis usually associated with Streptococcal infection. Erysipelas of the upper limbs in women treated for breast cancer is relatively rare. We undertook a 10-year retrospective study identifying 26 cases of erysipelas of the upper limb following treatment for breast cancer; we describe the clinical, therapeutic, and evolutionary aspects. The age of our patients ranged from 37 to 80 years with a mean age of 53. All patients had a breast surgery and lymphadenectomy. Fifteen patients had chemotherapy and 23 had radiotherapy. The erysipelas appeared with an average of 5.23 years after cancer treatment (3 months to 15 years) and was recurrent in nine cases. Lymphedema occurred in eighteen patients. The first signs were fever and shivering in 25 patients. The clinical aspect was an inflammatory plaque. The physical findings of erysipelas included a raised edge (6 cases), blisters (1 case), purpura (1 case), and cellulitis (1 case). The portal of entry was not found in eleven patients. The upper limb was affected in all cases. Involvement of the axillary folds or the chest was observed in eight cases. Treatment with penicillin was undertaken for all patients; the length of treatment varied from 11 to 26 days. Lympadenectomy and radiotherapy in breast cancer may lead to lymphedema, which can be evident or sometimes discrete. Those patients who developed erysipelas in our series usually fared well with treatment, but many had recurrences attributed to persistent lymphedema. It was also of note that for many patients in this series, the portal of entry was not identified.
丹毒是一种通常与链球菌感染相关的细菌性皮下蜂窝织炎。在接受乳腺癌治疗的女性中，上肢丹毒相对罕见。我们进行了一项为期10年的回顾性研究，确定了26例乳腺癌治疗后上肢丹毒病例；我们描述了其临床、治疗和演变方面的情况。我们患者的年龄在37岁至80岁之间，平均年龄为53岁。所有患者均接受了乳房手术和淋巴结清扫术。15例患者接受了化疗，23例接受了放疗。丹毒平均在癌症治疗后5.23年出现（3个月至15年），9例复发。18例患者发生了淋巴水肿。25例患者的首发症状为发热和寒战。临床症状为炎性斑块。丹毒的体格检查发现包括边缘隆起（6例）、水疱（1例）、紫癜（1例）和蜂窝织炎（1例）。11例患者未发现感染入口。所有病例均累及上肢。8例观察到腋窝皱襞或胸部受累。所有患者均接受青霉素治疗；治疗时间从11天到26天不等。乳腺癌的淋巴结清扫术和放疗可能导致淋巴水肿，其可能明显或有时不明显。在我们的系列研究中，发生丹毒的患者通常治疗效果良好，但许多患者因持续性淋巴水肿而复发。还值得注意的是，在该系列研究中的许多患者中，未确定感染入口。
