Acute inflammatory edema as a variant of pseudocellulitis resolved after transcatheter aortic valve implantation

Acute inflammatory edema in the setting of bilateral lung transplantation

“… 1 Typical findings include erythematous and edematous plaques localized to fluid-dependent areas, such as the lower abdomen and proximal lower extremities. 2 In all 15 patients reported by Marchionne et al, 1 the bilateral thighs were involved, similar to what was observed in this patient. Classic sparing of areas of pressure such as sites of contact with external objects and the inguinal folds is typically seen in patients with AIE.…”

“…AIE has been predominantly reported to occur in patients with an elevated BMI likely due to the association of impaired lymphatic drainage and obesity. 2 Our patient, however, was malnourished and a had a BMI of 16.4 kg/m 2 , suggesting that alternate mechanisms may have contributed to its development. The patient’s prolonged hospitalization was further complicated by profound sepsis along with development of a hypervolemic state due to acute renal failure, leading to increased hydrostatic pressure and vascular permeability.…”

“…AIE is associated with the development of erythematous and edematous plaques, typically presenting in dependent areas in patients who are critically ill. 1 Predisposing risk factors include fluid overload, renal dysfunction, an elevated BMI, and hypoalbuminemia. 2 , 3 The precise pathogenetic mechanism is unclear; however, prevailing theories suggest that AIE develops secondary to volume overload in patients who are critically ill with impaired lymphatic drainage. 1 , 3 This in turn leads to dermal edema and tissue microtears, with subsequent activation of the inflammatory cascade.…”

“…Elevation of inflammatory markers and leukocytosis are variably present, reflecting an underlying inflammatory rather than infectious process. Skin biopsy may prove helpful in distinguishing AIE from cellulitis and other infectious dermatoses for which antimicrobials would be indicated, especially since this condition is found to be associated withpatients who are critically ill. 2 , 3 …”

“…AIE tends to be localized to the thighs, lower abdomen, and flanks in a dependent, pressure-sparing distribution. 2 Given the paucity of cases reported in the literature, little is known about the risk factors and clinical presentation of AIE. Herein, we present a rare case of AIE in a non-obese patient who had undergone bilateral lung transplantation.…”