Connor Matthew Pierce, Gamelli Richard
Loyola University of Chicago, Stritch School of Medicine, 2160 South First Ave, Maywood IL, 60153, USA.
Cases J. 2009 Dec 22;2:9377. doi: 10.1186/1757-1626-2-9377.
Lymphedema is a relatively common phenomenon. It is important that clinicians appreciate the relative risks imposed by this condition. While for some it may only represent a flaw in appearance, this condition can potentially have fatal consequences. Our case reports on the challenges of cellulitis in a lymphedematous extremity that progressed to septic shock.
A 37-year-old Hispanic male was transferred to the Burn Unit from an outside hospital for wound care of an extremely severe case of cellulitis. He suffered massive lymphedema of his lower extremity, with innumerable nodules and chronic skin changes. After 3 days of cellulitis, he was in critical condition and required intubation and vasopressors. With intense wound care and systemic antibiotics, he gradually recovered and was discharged in 16 days with his cellulitis resolved and ambulating independently.
Our case highlights the special care and attention that chronic lymphedema deserves. These patients can exhibit marked disfigurement and physical disability affecting them on both social and physical levels. They also are at great medical risk, as cellulitis almost cost our patient his life. Evidence indicates that lymphedema, no matter the etiology, is susceptible to cellulitis with both great propensity and virulence. Physicians should be aware of the great risk of lymphedema, strive to prevent deterioration and complications, and be prepared to educate and closely monitor these patients.
淋巴水肿是一种相对常见的现象。临床医生认识到这种情况所带来的相对风险很重要。虽然对一些人来说它可能仅表现为外观缺陷，但这种情况可能会产生致命后果。我们的病例报告了淋巴水肿肢体发生蜂窝织炎并进展为感染性休克的挑战。
一名37岁的西班牙裔男性从外院转入烧伤科，接受极严重蜂窝织炎的伤口护理。他下肢患有严重的淋巴水肿，有无数结节和慢性皮肤改变。蜂窝织炎发作3天后，他病情危急，需要插管和使用血管加压药。经过强化伤口护理和全身使用抗生素，他逐渐康复，16天后出院，蜂窝织炎消退且能独立行走。
我们的病例突出了慢性淋巴水肿应得到的特殊护理和关注。这些患者可能会出现明显的毁容和身体残疾，在社交和身体层面都对他们产生影响。他们还面临巨大的医疗风险，因为蜂窝织炎几乎夺走了我们患者的生命。有证据表明，无论病因如何，淋巴水肿都极易发生蜂窝织炎，且发病倾向和致病性都很强。医生应意识到淋巴水肿的巨大风险，努力预防病情恶化和并发症，并准备好对这些患者进行教育和密切监测。
