Atypical course of erysipelas and coexisting infections. Case study and literature review
Anna Martyniuk1, Stanisław Górski2, Anna Górska1
1 Department of Family Medicine and Community Nursing, Medical University of Białystok, Poland
2 Department of Medical Didactics, Jagiellonian University Medical College, Cracow, Poland
Correspondence: Anna Martyniuk, Pogodna 29 C/22 A, 15-365 Białystok, Poland, tel.: +48 510 771 678, e-mail: firstname.lastname@example.org
Erysipelas is an acute, erythematous, rapidly spreading skin infection, usually caused by beta-haemolytic group A Streptococcus bacteria. The disease is usually located on the legs and toes, less frequently on the face. One of the predisposing factors for the development of erysipelas are coexisting infections. The aim of the work was to attempt to determine whether there was any connection between the atypical course of erysipelas and Helicobacter pylori infection in a 47-year-old female patient. The patient had a history of treatment for chronic otitis media with effusion and recurring abdominal pain. The current disease started abruptly with fever, erythematous skin lesion located on the right cheek and severe pain in the right ear. After a few days, the facial erythema got worse, oedema appeared on the right side of the face and redness, oedema and pain in the auricle could be observed. After examinations by an ENT specialist and a dermatologist, erysipelas of the face, auricle and external auditory meatus was diagnosed. The diagnosis was confirmed by bacteriological examination. As a result of antibiotic therapy skin lesions subsided and the patient’s general condition improved. As the dyspeptic symptoms exacerbated, a diagnostic test was performed and a coexisting Helicobacter pylori infection was diagnosed. The overall clinical picture and data obtained from medical literature suggest that the coexisting Helicobacter pylori infection could have contributed to both the chronic otitis media with effusion and atypical course of erysipelas. According to medical literature, in the case of patients with dyspeptic symptoms, Helicobacter pylori bacteria can be transferred from the lining of the stomach upwards to the oral cavity, middle ear and paranasal sinuses. Kariya et al. in their review of original work suggested that Helicobacter pylori may contribute to the exacerbation of an existing inflammation in the middle ear, which is a microaerophilic environment required for this bacteria to grow. In conclusion, it seems that constant stimulation of the immune system by Helicobacter pylori could have caused the system to become dysregulated and weakened, which probably accounted for the atypical course of erysipelas in the patient described.