Refractory edema and erythema of the abdominal wall

Abstract

HistoryAn 85-year-old female patient was referred to us with a suspected diagnosis of erysipelas of the lower abdomen, after seven days of systemic treatment with amoxicillin/clavulanic acid had not led to any improvement. The antibiotic had to be stopped prematurely due to angioedema of the tongue. The pruritic, slightly warm erythema with accompanying dysesthesia (sensation of stinging and distension) had developed over a period of four weeks (Figure 1 a); excoriations from scratching were considered possible portals of entry. An abscess was ruled out by ultrasound. Given multiple comorbidities (COPD, coronary heart disease, Clinical examination of the lower abdomen showed a poorly demarcated, warm erythema, measuring 20×15 cm, with accompanying lymphedema. In addition, there were isolated linear scratch marks (excoriations).