Bullous Erysipelas

Dewi Shinta / C111 09 879

Munirah Binti Hamidom / C111 10 838

Patient Identity

Name : Mr. O

Date of birth / Age : 20-05-1969 / 45 y.o

Occupation : Wiraswasta

Address : Tikala Toraja Utara

Marital status : married

Religion : Christian

Anamnesis

Patient admitted to hospital with complaints of pain

accompanied by swelling and blisters on the right
foot suffered since 10 days ago. Originally just a
small wound, and become wide. History of fever (+)
one day before admitted. History of previous
treatment (+). Food and drugs allergy history is
undeniable.

Physical Examination

Generalized status :

Vital Sign : - BP : 100/70 mmHg

- Breathing : 20x/min
- Pulse : 80x/min
- Temperature : 36.3
Head : - Sclera : ikterus (-)
- Conjunctivae : anemia (-)
- Lips : Cyanosis (-)

Head : - Sclera : ikterus (-)

- Conjunctivae : anemia (-)
- Lips : Cyanosis (-)
Cor / Lung : Normal
Abdomen

: Normal

Lymph gland : Normal

Dermatovenerology Status

Location : Regio extremitas inferior dextra

Efflorecent : Erythema, Udem, Bulla

Localized Status

Laboratory Examination

WBC : 37.000

APTT : 52,0

HGB : 13,9

GD : 77

PLT : 121.000

Ureum : 143

Alb : 2,5

Creatinine : 3,70

K : 3,8

Nn : 137

Cl : 110

Treatment

MBO talk (Menthol 0.15%, Boric acid 3%, Zinc

oxide 10%, Talk venetum add 100% m.f pulv da in
pot nol)

Ceftriaxone 2gr / 24hour / IV

Metronidazole 0.5gr / 12 jam / IV

Differential diagnosis :

Cellulitis

Diagnosis :

Bullous Erysipelas

Prognosis

Dubia et bonam

DISCUSSION
(Bullous Erysipelas)

Definition

Erysipelas is a superficial form of cellulitis typical skin

caused by group A Streptococcus. Group B
Streptococcus can cause erysipelas in neonates. It is an
acute infection disease.

Etiologi

Usually caused by Streptococcus B hemolyticus

Epidemiology

Often occur in infants, children, and the elderly, especially

those who are bed-ridden and malnourished. Erysipelas
often as a complication of surgical wound or from accident
injuries.

Factor :

- Race : All race

- Region : Tropis and Subtropis
- Hygiene : Bad hygiene
- Predisposition factor : DM, Upper respiratory infection,
malnourished

Pathogenesis
Bacteri enters
open wound

Imbalance system host, bacteria and

skin barrier function

Bacteria produces exotoxin which induces

the aggregation of trombosit and neutrophil

Blood capillary occluded

Swelling

Clinical Signs :

- Systemic symptoms : Fever and Malaise

- Main symptoms : Erythema is bright red in colored,
sirkumskrip, and rising edges with signs of acute
inflammation. Accompanied by edema, vesicle, and bulla.
Leukocytosis (+).
- If not treated it will extend to the surrounding especially
toward proximally.
- If often recurrent in the same spot can occur elephantiasis

Laboratory Examination :

- Blood test : Leukocytosis (+)

- Blood culture, nose and throat swab can isolate
Streptococcus B Hemolytic.

Differential Diagnosis

- Cellulitis : In this disease there infiltrate in subcutaneous.

Treatment

- Topical : Apply with boric acid solution 3% or NaCl

0.9% solution.
- Systemic :
- Antipyretic dan analgetic
- Penicillin 0.6-1.5 mega unit for 5-10 days
- Cephalosporin 4x400 mg for 5 days

Prognosis

Dubia et bonam

Reference

Saavendra, A.,et al.,Soft Tissue Infection: Cellulitis,

gangrenous cellulitis, and mayonecrosis, in Fitzpatrick's
Dermatology in General Medicine, K.Wolff, et al.,
editors.2008, McGraw Hill. p.1720-1722.
Juanda, A.,Pioderma, in Ilmu Penyakit Kulit dan
Kelamin, P.D.d.A.Djuanda, editors.2013, FKUI. p.57-63
Erisipelas, in Ilmu Penyakit Kulit, P.D.M.Harahap,
editor. 2002, Hipocrates. p.58
Erisipelas, In Atlas Berwarna Saripati Penyakit Kulit,
S.K.K.Prof.Dr.R.S.Siregar, editor. 2002, Penerbit Buku
Kedokteran EGC. p.57-58

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