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J Am Acad Dermatol. 2019 Oct;81(4):931-936. doi: 10.1016/j.jaad.2019.05.083. Epub 2019 Jun 1.

Acute inflammatory edema: A mimicker of cellulitis in critically ill patients.

Author information

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.

KEYWORDS:

acute inflammatory edema; cellulitis; fluid overload; inpatient dermatology; lymphatic return; pseudocellulitis

PMID:
31163234
DOI:
10.1016/j.jaad.2019.05.083

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