Persistent periorbital and facial lymphedema associated with Group A beta-hemolytic streptococcal infection (erysipelas).
Chronic lymphedema is both a risk factor for and consequence of erysipelas (cellulitis). We report a case of a 62-year-old woman with rheumatoid arthritis treated with etanercept and prednisone, who developed chronic periorbital lymphedema 2 months after Group A beta-hemolytic streptococcus infection of the face. She had significant ptosis OS and thickened, hyperpigmented periorbital skin. Biopsies were consistent with chronic lymphedema. Of note, on 6 months follow-up, the patient's appearance was improved though she still had residual ptosis. A period of extended observation may be warranted in these cases.
Buckland
Golden T
GT
Department of Ophthalmology, Division of Dermatology and Dermatopathology, Albany Medical College, Albany, New York, USA. gtb@freekfly.com
Carlson
J Andrew
JA
Meyer
Dale R
DR
D001172:Arthritis, Rheumatoid / Q000150:complications / Q000188:drug therapy; D002908:Chronic Disease; D004359:Drug Therapy, Combination; D004886:Erysipelas / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy; D000068800:Etanercept; D005148:Facial Dermatoses / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology*; D005260:Female; D006801:Humans; D007074:Immunoglobulin G / Q000627:therapeutic use; D008209:Lymphedema / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology*; D008279:Magnetic Resonance Imaging; D008875:Middle Aged; D009916:Orbital Diseases / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology*; D011241:Prednisone / Q000627:therapeutic use; D018124:Receptors, Tumor Necrosis Factor / Q000627:therapeutic use
D007074:Immunoglobulin G; D018124:Receptors, Tumor Necrosis Factor; D000068800:Etanercept; D011241:Prednisone