Erysipeloid in a Man With Joint Stiffness

A 55-year-old-man complained of joint stiffness and red, mildly tender plaques on his fingers. He had recently sustained a trauma to the hand while at his job as a fish handler. The condition was diagnosed as erysipeloid-a skin infection caused by the gram-positive bacillus Erysipelothrix rhusiopathiae.

An occupational infection seen in farmers and meat and poultry handlers, the distinctive cellulitis-erysipeloid-is the primary manifestation of infection with this bacillus. Infective endocarditis and septic arthritis are associated systemic diseases, but they rarely occur.

Drs Charles E. Crutchfield III and Eric J. Lewis of Minneapolis report that erysipeloid lesions most commonly are found on the fingers and hands and extend peripherally, often with central clearing. The eruptions can itch and burn, and nearby joints may be stiff. Generally, the disease is self-limited and runs about a 3-week course. This patient was treated with education and reassurance, and the rash cleared in 3 to 4 weeks. Alternatively, intramuscular penicillin G benzathine or oral erythromycin may be used.