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

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

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.

MeSH terms

  • Abdomen
  • Acute Disease
  • Aged
  • Body Water
  • Cellulitis / diagnosis*
  • Critical Illness
  • Dermatitis / diagnosis*
  • Dermatitis / etiology*
  • Diagnosis, Differential
  • Edema / diagnosis*
  • Edema / etiology*
  • Female
  • Humans
  • Male
  • Middle Aged
  • Thigh