Concomitant Venous Thrombosis in Cellulitis of the Upper Extremity

Abstract

Objectives Concurrent thrombosis is observed in up to 15 % of the patients with cellulitis of the lower extremity. The risk of concomitant venous thrombosis in patients with upper extremity cellulitis has not been investigated, yet. Aim of this study is to examine the frequency of concomitant venous thrombosis in patients with cellulitis of the upper extremity and to identify risk factors, comorbidities, and complications.

Materials and Methods From 2014 to 2021, patients with cellulitis of the arm that received duplexsonography of the same limb were included. Files were reviewed for demographic data, comorbidities, and risk factors.

Results 53 patients with upper limb cellulitis were included. In 11.3 % of the patients (n = 6), concomitant venous thrombosis of the upper extremity was detected. Three patients had deep arm thrombosis (brachial and subclavian veins), three had superficial vein thrombosis.

Conclusion Cellulitis may increase the risk for venous thrombosis. Venous catheters and chronic lymphedema favor the occurrence of both cellulitis and venous thrombosis. Oncological patients are at particular risk for developing concomitant venous thrombosis.

Zusammenfassung

Zielsetzung Bei bis zu 15% der Patienten mit Erysipel der unteren Extremität wird eine begleitende Thrombose als Zufallsbefund festgestellt. Bei Erysipelen der oberen Extremität wurde das Risiko für das gleichzeitige Auftreten von Thrombosen bislang nicht untersucht. Ziel dieser Studie ist es, die Häufigkeit von Venenthrombosen bei Patienten mit Erysipel der oberen Extremität zu erheben und Risikofaktoren, Komorbiditäten und Komplikationen zu ermitteln.

Patienten und Methoden Alle Patienten mit Erysipel am Arm, die zwischen 2014 und 2021 eine Duplexsonografie dieses Arms erhielten, wurden eingeschlossen, und deren demografische Daten, Komorbiditäten und Risikofaktoren wurden ausgewertet.

Ergebnisse 53 Patienten mit Erysipel der oberen Extremität wurden eingeschlossen. Bei 11,3% dieser Patienten (n=6) wurde eine begleitende Armvenenthrombose festgestellt. Bei 3 Patienten fand sich eine tiefe Armvenenthrombose (V. subclavia, V. brachialis), bei 3 Patienten zeigte sich eine oberflächliche Armvenenthrombose.

Zusammenfassung Erysipele können das Risiko einer venösen Thrombose erhöhen. Venenkatheter und chronische Lymphödeme begünstigen das Auftreten sowohl von Erysipelen als auch von Venenthrombosen. Onkologische Patienten sind besonders gefährdet, gleichzeitig eine venöse Thrombose zu entwickeln.

Schlüsselwörter

Entzündung - venöse Thrombose - Erysipel - obere Extremität - Lymphödem

Keywords

inflammation - venous thrombosis - cellulitis - upper extremity - lymphedema

Publikationsverlauf

Artikel online veröffentlicht:
14. August 2023

• References

• 1 Sullivan T, de Barra E. Diagnosis and management of cellulitis. Clin Med (Lond) 2018; 18: 160-163 DOI: 10.7861/clinmedicine.18-2-160. (PMID: 29626022)
• 2 Krasagakis K, Valachis A, Maniatakis P. et al. Analysis of epidemiology, clinical features and management of erysipelas. Int J Dermatol 2010; 49: 1012-1017 DOI: 10.1111/j.1365-4632.2010.04464.x. (PMID: 20931671)
• 3 Bläckberg A, Trell K, Rasmussen M. Erysipelas, a large retrospective study of aetiology and clinical presentation. BMC Infect Dis 2015; 15: 402 DOI: 10.1186/s12879-015-1134-2. (PMID: 26424182)
• 4 Lazzarini L, Conti E, Tositti G. et al. Erysipelas and cellulitis: clinical and microbiological spectrum in an Italian tertiary care hospital. J Infect 2005; 51: 383-389 DOI: 10.1016/j.jinf.2004.12.010. (PMID: 16321649)
• 5 Esmon CT. Interactions between the innate immune and blood coagulation systems. Trends Immunol 2004; 25: 536-542 DOI: 10.1016/j.it.2004.08.003. (PMID: 15364056)
• 6 van der Poll T, Herwald H. The coagulation system and its function in early immune defense. Thromb Haemost 2014; 112: 640-648 DOI: 10.1160/TH14-01-0053. (PMID: 24696161)
• 7 Sun H. The interaction between pathogens and the host coagulation system. Physiology (Bethesda) 2006; 21: 281-288 DOI: 10.1152/physiol.00059.2005. (PMID: 16868317)
• 8 Linder A, Johansson L, Thulin P. et al. Erysipelas caused by group A streptococcus activates the contact system and induces the release of heparin-binding protein. J Invest Dermatol 2010; 130: 1365-1372 DOI: 10.1038/jid.2009.437. (PMID: 20107486)
• 9 Levi M, van der Poll T. Coagulation and sepsis. Thromb Res 2017; 149: 38-44 DOI: 10.1016/j.thromres.2016.11.007. (PMID: 31410983)
• 10 Faust SN, Levin M, Harrison OB. et al. Dysfunction of endothelial protein C activation in severe meningococcal sepsis. N Engl J Med 2001; 345: 408-416 DOI: 10.1056/NEJM200108093450603. (PMID: 11496851)
• 11 Mortazavi M, Samiee MM, Spencer FA. Incidence of deep vein thrombosis in erysipelas or cellulitis of the lower extremities. Int J Dermatol 2013; 52: 279-285 DOI: 10.1111/j.1365-4632.2012.05619.x. (PMID: 22913433)
• 12 Zaghdoudi I, Rezgui M, Zouaoui W. et al. Incidence of deep venous thrombosis in patients with erysipelas of the leg: prospective study of 30 cases in an emergency department. Pathophysiol Haemost Thromb 2008; 36: 271-274 DOI: 10.1159/000252824.
• 13 Gawaz A, Gonser L, Strölin A. et al. Concomitant thrombosis in patients with cellulitis as incidental finding. Clin Hemorheol Microcirc 2022; DOI: 10.3233/CH-221519.
• 14 Branson SV, McClintic E, Yeatts RP. Septic Cavernous Sinus Thrombosis Associated With Orbital Cellulitis: A Report of 6 Cases and Review of Literature. Ophthalmic Plast Reconstr Surg 2019; 35: 272-280 DOI: 10.1097/IOP.0000000000001231. (PMID: 30320718)
• 15 Heil J, Miesbach W, Vogl T. et al. Deep Vein Thrombosis of the Upper Extremity. Dtsch Arztebl Int 2017; 114: 244-249 DOI: 10.3238/arztebl.2017.0244. (PMID: 28446351)
• 16 Drouin L, Pistorius M-A, Lafforgue A. et al. Upper-extremity venous thrombosis: a retrospective study about 160 cases. Rev Med Interne 2019; 40: 9-15
• 17 Jawad AS. Upper-extremity thrombosis. J R Soc Med 2004; 97: 156-157 DOI: 10.1258/jrsm.97.3.156-b. (PMID: 14996983)
• 18 Rijneveld AW, Weijer S, Bresser P. et al. Local activation of the tissue factor-factor VIIa pathway in patients with pneumonia and the effect of inhibition of this pathway in murine pneumococcal pneumonia. Crit Care Med 2006; 34: 1725-1730 DOI: 10.1097/01.CCM.0000218807.20570.C2.
• 19 Levi M, Schultz MJ, Rijneveld AW. et al. Bronchoalveolar coagulation and fibrinolysis in endotoxemia and pneumonia. Crit Care Med 2003; 31 (Suppl. 04) S238-S242 DOI: 10.1097/01.CCM.0000057849.53689.65. (PMID: 12682446)
• 20 Ploton G, Pistorius MA, Raimbeau A. et al. A STROBE cohort study of 755 deep and superficial upper-extremity vein thrombosis. Medicine (Baltimore) 2020; 99: e18996 DOI: 10.1097/MD.0000000000018996. (PMID: 32028410)
• 21 Monreal M, Ruiz J, Olazbal A. et al. Deep venous thrombosis and the risk of pulmonary embolism: a systematic study. Chest 1992; 102: 677-681
• 22 Levy MM, Bach C, Fisher-Snowden R. et al. Upper extremity deep venous thrombosis: reassessing the risk for subsequent pulmonary embolism. Ann Vasc Surg 2011; 25: 442-447 DOI: 10.1016/j.avsg.2011.01.005. (PMID: 21549911)
• 23 Hingorani A, Ascher E, Hanson J. et al. Upper extremity versus lower extremity deep venous thrombosis. Am J Surg 1997; 174: 214-217 DOI: 10.1016/s0002-9610(97)00088-3. (PMID: 9293848)
• 24 van Bijnen EM, Paget WJ, den Heijer CD. et al. Primary care treatment guidelines for skin infections in Europe: congruence with antimicrobial resistance found in commensal Staphylococcus aureus in the community. BMC Fam Pract 2014; 15: 175 DOI: 10.1186/s12875-014-0175-8.
• 25 Brennecke S, Hartmann M, Schöfer H. et al. Therapie des Erysipels in Deutschland und Österreich--Ergebnisse einer Umfrage an deutschen und österreichischen Hautkliniken [Treatment of erysipelas in Germany and Austria--results of a survey in German and Austrian dermatological clinics]. J Dtsch Dermatol Ges 2005; 3: 263-270 DOI: 10.1111/j.1610-0387.2005.04799.x.
• 26 Elliott G. Upper-extremity deep vein thrombosis. Lancet 1997; 349: 1188-1189 DOI: 10.1016/S0140-6736(05)62408-7. (PMID: 23093319)
• 27 Pereira de Godoy JM, Azoubel LM, Guerreiro Godoy Mde F. Erysipelas and lymphangitis in patients undergoing lymphedema treatment after breast-cancer therapy. Acta Dermatovenerol Alp Pannonica Adriat 2009; 18: 63-65 (PMID: 19588059)
• 28 Masmoudi A, Maaloul I, Turki H. et al. Erysipelas after breast cancer treatment (26 cases). Dermatol Online J 2005; 11: 12-12 (PMID: 16409908)
• 29 Merchant SJ, Chen SL. Prevention and management of lymphedema after breast cancer treatment. Breast J 2015; 21: 276-284 DOI: 10.1111/tbj.12391. (PMID: 25772311)
• 30 Zimmermann A, Wozniewski M, Szklarska A. et al. Efficacy of manual lymphatic drainage in preventing secondary lymphedema after breast cancer surgery. Lymphology 2012; 45: 103-112 (PMID: 23342930)