Prevalence of Pre-Existing Subclinical Leg Lymphedema in Patients with Erysipelas

Abstract

Background:

Erysipelas is a common bacterial infection of the skin and subcutaneous tissue. In certain patients, the triggering factor can be identified, but in many cases, it remains elusive. Prior research indicates that pre-existing subclinical lymphedema in patients might serve as a triggering factor for the development of erysipelas.

Objectives:

We investigated the prevalence of subclinical lymphedema on the unaffected leg in patients with a recent history of erysipelas by performing lymphoscintigraphy of both legs.

Methods:

In a prospective study, 106 consecutive patients (mean age 53.4 years; 87/19: men/women) 3 to 6 months after erysipelas episode were included in the study. In all patients, lymphoscintigraphy was performed by subcutaneous injection of Tc-99m-labelled human albumin into both feet according to standard protocol.

Results:

Subclinical lymphedema on the unaffected leg was found in 82% of patients, with a similar prevalence in all genders and age groups, and in patients with or without erysipelas risk factors. Moreover, the prevalence of subclinical lymphedema increased proportionally with the number of erysipelas episodes: among those with a single episode, 74% exhibited subclinical lymphedema, whereas among those with 3 or more episodes, the prevalence was 100%.

Conclusions:

We found a high prevalence of subclinical lymphedema in the unaffected leg in erysipelas patients, indicating its frequent bilateral occurrence and its role as a primary trigger of erysipelas. Moreover, our study highlights subclinical lymphedema as a risk factor for erysipelas recurrences. Thus, our clinical recommendation suggests bilateral leg compression therapy in erysipelas patients to prevent recurrence and lymphedema exacerbation.