Bullous Erysipeloid: An Atypical Manifestation in an Immunocompromised Patient – A Case Report

Abstract

Erysipeloid is a rare infection caused by Erysipelothrix rhusiopathiae. We report the case of a 58-year-old woman with HIV and spondylarthritis on immunosuppressants, who had a history of direct contact fish and shrimp, who presented with a progressive, painful plaque with central bullae on her left index finger. At her initial visit, she was diagnosed with bullous cellulitis and was treated with oral clindamycin (300 mg three times daily) and intravenous levofloxacin 750 mg once daily. Despite treatment, her condition worsened, necessitating hospitalization and surgical debridement. Microbiological culture from skin lesion confirmed the presence of Erysipelothrix rhusiopathiae, leading to the diagnosis of erysipeloid. Following a 14-day course of penicillin V, the patient showed significant clinical improvement. Atypical presentations of erysipeloid, as bullous lesions, can occur, particularly in immunocompromised host.