Vitiligo and Cellulitis

Pain and swelling of the left lower leg and a low-grade fever of 1 week's duration sent a 24-year-old African American man for medical evaluation. The patient had a history of vitiligo since childhood.

The patient denied any recent trauma or past injury. The family history was noncontributory. Skin depigmentation was noted on the lower extremities, trunk, face, back, and arms. The left lower calf was edematous, tender, erythematous, and warm. His temperature was 38.3°C (101°F); other vital signs were stable and pulses were intact.

Laboratory studies revealed an elevated erythrocyte sedimentation rate of 100 mm/h and a white blood cell count of 25,000/µL. A roentgenogram of the leg showed no evidence of periosteal elevation consistent with osteomyelitis; blood cultures were negative. No deep vein thrombosis was demonstrated on an ultrasonogram of the affected leg. Cellulitis was diagnosed.

Gopi Rana-Mukkavilli, MD of New York City comments that cellulitis in the setting of chronic vitiligo is unusual, unless the patient is being treated with corticosteroids. The cause of this patient's cellulitis was unknown. Vitiligo is an autoimmune disorder that is familial in 36% of cases.¹ The disorder involves circumscribed hypomelanosis of progressively enlarging amelanotic macules in a symmetric distribution around the body; circulating complement-binding antimelanocyte antibodies also are found. Associated autoimmune conditions, such as thyroiditis, pernicious anemia, and diabetes mellitus, affect a small percentage of persons with vitiligo.

UV therapy and corticosteroids have been used to treat vitiligo. Epidermal skin grafting is the newest treatment for this condition. Sunscreen use is also recommended.

A 14-day course of oral ciprofloxacin, 500 mg twice daily, was given for this patient's cellulitis. The symptoms completely resolved within 1 month without complications. The patient underwent UV therapy for the vitiligo.

REFERENCE:1.Wyngaarden JB, Smith LH, Bennett JC, eds. Cecil Textbook of Medicine. 19th ed. Philadelphia: WB Saunders Company; 1992.