Multifokale nekrotisierende zellulitis als komplikation eines erysipels bei chronischem lymphodem

In a patient suffering from chronic lymphedema an untreated relapse of erysipelas resulted in disseminated lesions of sharply demarcated subcutaneous gangrene due to a mixed infection with group B streptococci and Gram-negative bacteria, resembling bacterial synergistic gangrene. This rare disorder can be considered as a limited minor variant of necrotizing fasciitis. While the chronic lymphedema seems to be a risk factor, the failure to progress to fulminating necrotizing fasciitis may be explained by the absence of additional predisposing factors. Therapy consists of appropriate antibiotic treatment based on susceptibility tests combined with early surgical debridement.