Elizabeth M Marchionne1, Timothy H McCalmont2, Laura B Pincus2, Philip E LeBoit2, Lindy P Fox3. 1. Department of Dermatology, University of California San Francisco, San Francisco, California. 2. Department of Dermatology, University of California San Francisco, San Francisco, California; Department of Pathology, University of California San Francisco, San Francisco, California. 3. Department of Dermatology, University of California San Francisco, San Francisco, California. Electronic address: lindy.fox@ucsf.edu.
Abstract
BACKGROUND: Inpatient dermatology consultations for treatment-refractory or atypical cellulitis are common. In critically ill patients, differentiating cellulitis from its mimickers can be challenging. OBJECTIVE: We describe acute inflammatory edema, a likely underrecognized variant of pseudocellulitis. METHODS: We reviewed the charts of 15 patients with this diagnosis, seen by the inpatient dermatology consultation service at the University of California at San Francisco between 2009 and 2017. RESULTS: The cohort consisted of 9 women and 6 men with an age range of 52-73 years. Acute inflammatory edema presents as bilateral, erythematous, and edematous plaques, most commonly involving the thighs and lower abdomen, sparing areas of increased pressure on the skin. There is a predilection for patients with high body mass index and those with clinical or quantitative findings of fluid overload. CONCLUSION: We propose a 3-part pathogenesis of acute inflammatory edema: 1) acute-onset volume overload 2) in patients with impaired lymphatic return 3) leads to dermal edema, microtears in connective tissue, and an influx of inflammation.
BACKGROUND: Inpatient dermatology consultations for treatment-refractory or atypical cellulitis are common. In critically illpatients, differentiating cellulitis from its mimickers can be challenging. OBJECTIVE: We describe acute inflammatory edema, a likely underrecognized variant of pseudocellulitis. METHODS: We reviewed the charts of 15 patients with this diagnosis, seen by the inpatient dermatology consultation service at the University of California at San Francisco between 2009 and 2017. RESULTS: The cohort consisted of 9 women and 6 men with an age range of 52-73 years. Acute inflammatory edema presents as bilateral, erythematous, and edematous plaques, most commonly involving the thighs and lower abdomen, sparing areas of increased pressure on the skin. There is a predilection for patients with high body mass index and those with clinical or quantitative findings of fluid overload. CONCLUSION: We propose a 3-part pathogenesis of acute inflammatory edema: 1) acute-onset volume overload 2) in patients with impaired lymphatic return 3) leads to dermal edema, microtears in connective tissue, and an influx of inflammation.
Authors: Mojahed Mohammad K Shalabi; Nicole N Dacy; Ronald E Grimwood; Katherine Fiala; Meredith Amenell Journal: Proc (Bayl Univ Med Cent) Date: 2021-09-21
Authors: Gabriel Bronz; Pietro O Rinoldi; Camilla Lavagno; Mario G Bianchetti; Sebastiano A G Lava; Federica Vanoni; Gregorio P Milani; Isabella Terrani; Alessandra Ferrarini Journal: Dermatology Date: 2021-09-22 Impact factor: 5.197