Association of erysipelas with acute renal failure

Abstract

Sir, The aim of the current letter is to report the association of erysipelas to acute renal failure. Erysipelas is an acute dermo-hypodermal infection of bacterial origin, in particular, group A beta-hemolytic streptococcus. The lower limbs are affected in more than 80% of the cases and the identified risk factors are disruption of the cutaneous barrier, lymphedema and obesity [1, 2]. There are few local complications associated with erysipelas; abscesses can occur in patients but septicemia is rare [3]. However, there have been few reports associating erysipelas to acute renal failure [4, 5] and the physiopathologic mechanism remains unknown. The case of a 23-year-old patient with a 10-day history of injury to the right leg is reported. The patient evolved with hyperemia, pain and edema of the limb after 5 days. At physical examination, hyperemia, edema, formation of blisters with signs of necrosis, lymphangitis in the great saphenous vein region and inguinal lymphadenitis were identified. The clinical diagnosis was erysipelas and so the patient was prescribed crystalline penicillin. A biochemical assessment identified altered renal function requiring hemodialysis. The main biochemical alterations included creatinine 10.2 mg/dl, urea 256 mg/dl, leukocytes 49800, C-reactive protein 30 mg/dl, Antistreptolysin O Titer 400 IU/ml and uric acid 14.3 mg/dl in ultrasound of the abdomen showed the kidneys with increased bilateral echogenicity. Two blood cultures were performed giving negative results. The patient’s condition evolved with normalization of the renal function and improvement of the erysipelas. This study describes the case of an apparently healthy young man who after injuring his leg evolved with erysipelas associated to acute kidney failure. Examinations were carried out before starting treatment reducing the possibility of the drugs aggravating the genesis of the kidney failure. In this case, the clinical improvement suggests a possible reversal of the disease. The diagnosis of kidney failure was a finding of the biochemical examinations which are routinely performed in our service; however, the patient had not presented with symptoms of renal involvement. Thus, erysipelas should be considered in cases such as this, even though this association is very rare, as well as other infectious diseases [4, 6]. J. M. P. de Godoy (&) M. K. Irikura R. de Moura Alvares Department of Cardiology and Cardiovascular Surgery, Medicine School in Sao Jose do Rio Preto-FAMERP, Floriano Peixoto, 2950, Sao Jose do Rio Preto, SP 15020-010, Brazil e-mail: godoyjmp@riopreto.com.br