Incidence of Deep Venous Thrombosis in Patients with Erysipelas of the Leg: Prospective Study of 30 Cases in an Emergency Department

Abstract

The treatment of lower limb erysipelas is based on anti-streptococcal antibiotherapy. The indication of adjuvant anticoagulant therapy is not clear because of the lack of data about the incidence of deep venous thrombosis (DVT) in these patients. We performed a prospective study using a colour Doppler vein exploration combined with ultrasonography within the first 48 h, with evaluation of clinical probability of DVT according to the Wells score to assess the incidence of DVT in patients with erysipelas of the lower limb. Of 30 patients studied, 3 DVT were diagnosed: 2 distal DVT (posterior tibial vein) and 1 proximal DVT (superficial femoral vein) in patients having a clinical score ≥3. Pulmonary embolism was diagnosed in 2 cases. The incidence of DVTin our study was 10%.DVT should be considered in patients with erysipelas of the lower limb having a high pretest clinical probability.

Incidence of deep vein thrombosis in erysipelas or cellulitis of the lower extremities

“…They diagnosed one proximal and two distal DVTs (10.0%). Ventilation–perfusion scans in two of these three patients demonstrated asymptomatic bilateral sub‐segmental pulmonary embolism 13 …”

“…Therefore, only two (2.7%) of 74 patients with a final diagnosis of cellulitis had proven DVT. 19 Finally, Zaghdoudi et al 13 prospectively studied the incidence of DVT in 30 hospitalized patients with erysipelas of the leg by performing compression US. They diag-nosed one proximal and two distal DVTs (10.0%).…”

“…Ventilation-perfusion scans in two of these three patients demonstrated asymptomatic bilateral sub-segmental pulmonary embolism. 13 A smaller number of studies report complications of erysipelas and cellulitis that include thromboembolism, without performing a systematic investigation for DVT ( Table 2). Investigation for DVT was performed only in the presence of clinical suspicion.…”

“…However, as the two conditions share a number of presenting features (lower extremity pain, erythema, swelling), there is the potential that one might be misdiagnosed for the other 12 . The incidence of DVT in patients with suspected erysipelas or cellulitis has been repeatedly but inadequately investigated during recent decades and reported frequencies range from 0% to 15% 12–21 . These studies utilized a variety of imaging procedures with different levels of technology, sensitivity and specificity.…”

“…Frequencies of the association between DVT and cellulitis or erysipelas reported in the literature are highly variable, ranging from 0% to 15% 12 . Accordingly, it is unclear whether patients with erysipelas or cellulitis of the lower extremities may benefit from prophylactic anticoagulation to prevent DVT and/or pulmonary embolism, or systematic investigation to rule out concomitant DVT 13 . The main objective of this review is to provide an estimate of the incidence of DVT in patients with cellulitis or erysipelas based on the available literature.…”