Erysipeloid in a Meatpacker

After 1 week of scratching a pruritic, reddish rash on a swollen hand and enduring a “burning sensation,” a 43-year-old man visited his physician. The patient worked as a meatpacker. He had no other medical conditions, took no medications, and had no known drug allergies.

Swelling, erythema, and tenderness of the left hand were noted. There was no lymphangitis, lymphadenitis, fever, ulcerations, or joint swelling. All laboratory findings were within normal limits, except for a slightly elevated white blood cell count. A biopsy of the lesion and follow-up cultures revealed Erysipelothrix rhusiopathiae from the inoculum. Erysipeloid, or meat-handlers' disease, was diagnosed.

Gopi Rana-Mukkavilli, MD of New York writes that E rhusiopathiae is a rare cause of disease in humans. It is a gram-positive, nonmotile, noncapsulated aerobic bacillus that infects persons who handle fish, meat, and poultry. Erysipeloid, which is seen most often in the summer and early fall, commonly occurs by inoculation of the fingers and hands. Sepsis develops in about a third of patients¹; complications include septic arthritis and endocarditis. Local lesions, as seen in this patient, result in purplish red, nonvesiculated inflammation that is sharply defined by an irregular, raised border. Although the fingers and hand usually are affected, the terminal phalanges typically are spared.

Erysipeloid is usually self-limited; it subsides spontaneously in about 3 weeks. Because this patient had symptoms, he was given penicillin G benzathine, 600,000 units IM in each buttock. At 1-month follow-up, the lesion and symptoms had disappeared.

REFERENCE:1. Morris A. Clinical Evidence. London: BMJ Publishing Group; December 2000, No. 4:957-960.