Approach considerations

In case of classic erysipelas, there is no requirement of laboratory workup for treatment or

diagnosis. However, elevations and leukocytosis in ESR (erythrocyte sedimentation rate) and

CRP (C-reactive protein) are common. Routine tissues as well as blood cultures aren’t cost-

effective as they are having extremely poor yield and

results have very low impact on

management.

Usually imaging studies aren’t indicated and they are of low yield. MRI (magnetic resonance

imaging) as well as bone scintigraphy will be helpful when earlier osteoarticular involvement

will be suspected. In such settings, typically standard radiographic findings will be normal.

Histological Findings

Erysipelas Histologic hallmarks are vascular dilatation, streptococcal invasion of tissues and

lymphatics, and marked dermal edema. The bacterial invasion results in dermal inflammatory

infiltrate that includes neutropils as well as mononuclear cells. Epidermis often is secondarily

involved. Bacterial invasion rarely of local blood vessels can be seen.

Bacterial Cultures

These are positive in just five percent of the cases whereas culture and Gram stain of rash

usually not helpful. Bacterial cultures however might be useful when question of concern or

diagnosis about bacteremia exists with metastatic infection. Cultures can be of little benefits

in patients who have different intravascular devices or artificial joints or are with prosthetic

heart valves or toxic-appearing or immuno-compromised patients. From portal of entry,

bacterial cultures can be highly helpful in individuals having atypical clinical presentations.