Erysipelas in Early Infancy: A Rare Clinical Presentation

Background: Erysipelas is an acute bacterial dermo-hypodermitis that is rarely reported in infants. Disruption of the epidermal barrier in atopic dermatitis may provide a portal of entry for bacterial infection. Case Presentation: A 16-month-old girl with poorly managed atopic dermatitis since four months of age was admitted with fever and a painful, erythematous, oedematous plaque of the left lower limb associated with two tense vesicles. Pruritic vesicular lesions had initially appeared on both lower limbs and the scalp, followed by painful swelling of the left lower limb. Examination identified crusted lesions and ipsilateral tender inguinal lymphadenopathy. Laboratory investigations showed leucocytosis of 40 660/mm³, a neutrophil count of 30 100/mm³ and a C-reactive protein level of 185 mg/L. Soft-tissue ultrasonography demonstrated diffuse infiltration without a visible collection. On the basis of the clinical and laboratory findings, bullous erysipelas arising on impetiginised atopic dermatitis was suspected. Treatment with amoxicillin-clavulanic acid at 150 mg/kg/day resulted in clear clinical and biological improvement within 48 hours. Antibiotic therapy was continued for 14 days, and a 24-hour proteinuria test performed three weeks after hospitalisation was negative. Conclusion: This case illustrates bullous erysipelas in a young child with atopic dermatitis and suggests a possible contribution of impaired skin barrier function. Early clinical recognition and treatment were followed by a favourable course, although a single case cannot establish causality or comparative treatment effectiveness.