CHARACTERISTICS OF FACIAL ERYSIPELAS ON THE BACKGROUND OF SECONDARY IMMUNODEFICIENCY

Abstract

SUMMARY. A case of primary facial hysteria in an immunocompromised person is described. In the presented case, the diagnosis of facial erysipelas was complicated due to the atypicality of clinical and laboratory-instrumental manifestations, caused, apparently, by secondary immunodeficiency:

1) the onset of the disease without a prodrome, not from manifestations of general intoxication, but directly from a local skin lesion that preceded the fever by 2 days;

2) absence of classic erythema in the form of tongues of flame and clear borders of the inflammation area without a peripheral ridge;

3) erysipelas of the face acquires the appearance of a butterfly: almost symmetrical erythema of the cheekbones, which, however, is significantly inferior to edema, which spreads beyond the erythema and is more significant in places with developed subcutaneous tissue (primarily eyelids);

4) absence of neutrophilic leukocytosis due to a shift of the formula to the left;

5) areas of hyperthermia on the thermogram are not bright, the temperature difference does not reach significant figures (ΔТ=0.8–1.1 ° versus 3–8 ° in the absence of immunodeficiency);

6) the normalization of the thermographic picture significantly lags behind the clinical signs of convalescence, which requires prolongation of antibiotic therapy and/or its addition or change of the drug.

Recognition of such cases is important to ensure prompt and adequate therapeutic intervention.