Érysipèle sur carcinome épidermoïde récidivant de la grande lèvre après radio-chimiothérapie

Abstract

The erysipelas is a bacterial infection most frequently due to (85% of cases) streptococcus β-hemolytic of group A (SGA), resulting in non-necrotizing dermo-hypodermitis. Many factors may play a role in its occurrence such as general factors: diabetes, immunosuppression, chemotherapy, radiotherapy as well as locoregional ports of entry such as leg ulcer, an insect bite, intertrigo. The occurrence of erysipelas associated with recurrent squamous cell carcinoma after radiochemotherapy is exceptional, requiring early treatment of dermo-hypodermitis as well as suitable and multidisciplinary management of the carcinoma. The mechanism of the occurrence of erysipelas after radiotherapy coincides with its pathophysiology. Indeed, this therapeutic component, which is very used to treat squamous cell carcinoma, alters lymphatic drainage resulting, very gradually, in lymph fibrosis thus weakening the defense mechanism. Its association with alteration of cellular immunity, also favored by radiotherapy and chemotherapy, can cause the occurrence of erysipelas in these patients. We report the case of a 50-year old female patient with a 1-year history of squamous cell carcinoma of the right labium majus treatment with radiochemotherapy with remission. Eight months later, the patient had recurrence. Evolution was marked by the appearance of a painful hot erythematous plaque on the right thigh suggesting erysipelas, confirmed by laboratory tests which showed an infection. The patient was put on antibiotic therapy with good improvement and then referred to the Department of Oncology for recurrence management.