Erysipeloid is characterized by erythematous to violaceous well-defined plaques with edema and raised borders. Vesicles, bullae, and erosions can also be present. The lesions of erysipeloid are generally located on the back of the hands and/or fingers. They are most often asymptomatic, but some patients may report mild pain, pruritus, or fever.
The diffuse / generalized form is rare and is characterized by similar cutaneous lesions in a widespread distribution. Unlike localized erysipeloid, patients with the diffuse / generalized form often report fever, lymphadenitis, and arthralgias.
In addition to the localized and diffuse cutaneous disease detailed above, the bacterium can also cause systemic disease, most often in the form of acute or subacute endocarditis. Endocarditis is rare and usually affects previously damaged valves.
The lesions of localized cutaneous erysipeloid often resolve without treatment in 3-4 weeks but may recur. Therefore, treatment with antibiotics is indicated in all forms of erysipeloid.
A26.0 – Cutaneous erysipeloid
400105005 – Erysipeloid
Differential Diagnosis & Pitfalls
- Cellulitis or erysipelas – Erysipeloid can be often differentiated from cellulitis on the basis of location (fingers and hands), the patient’s occupation, a history of animal or meat exposure, more violaceous appearance, and lack of severe systemic features.
- Acute irritant or allergic contact dermatitis
- "Seal finger" – etiologic agent likely Mycoplasma spp.
- Insect bite
- Fixed drug eruption
- Herpetic whitlow
- Herpes virus infections (herpes simplex virus or varicella zoster virus) with associated lymphangitic erythema
- Mycobacterium marinum infection
- Cat-scratch disease
- Sweet syndrome
- Cryptococcal cellulitis
- Pasteurella multocida infection
- Vibrio vulnificus infection
- Necrotizing fasciitis