Septicopyemic eruption: causes, symptoms, diagnosis, and treatment

Septicopyemic eruption is skin lesions caused by toxins produced by pathogens in bloodstream when septicopyemia occurs.


Causes

Common pathogens are staphylococcus aureus, hemolytic streptococcus, tetracoccus, pneumococcus, and Escherichia coli.


Signs and Symptoms

The incidence of septicopyemic eruption is 17% - 60.9%, and eruption usually occurs 2 - 8 days after onset.

Staphylococcal septicopyemic eruption can be seen in patients with staphylococcal sepsis, staphylococcal infection of internal organs, and staphylococcal pyoderma. Severe systemic symptoms such as chills and fever occur suddenly. Skin lesions are characterized by urticaria, petechiae, scarlet fever-like or measles-like rash, with pruritus or burning sensation, or different sized erythema, papules, blisters, nodules or migratory subcutaneous abscesses.

Streptococcal septicopyemic eruption is visible in streptococcal sepsis, peritonitis, otitis media, scarlet fever, and puerperal fever. Initial skin lesions are mainly pale purple, round or irregular, pinhead sized to coin sized or larger spots, or pale red acneiform papules, or scarlet fever-like rash, mostly with hemorrhagic changes in the early stage, developing into blisters, pustules or necrosis, forming ulcers.


Histopathology

In erythema, papules, and pustules, dermal edema, vasodilation, and perivascular inflammatory infiltration are visible, and abscess formation and bacteria in the spinous cell layer and upper dermis can be seen. Neutrophil, lymphocytic, and bacterial embolism are present in all blood vessels.


Diagnosis

On the basis of clinical manifestations, such as occurrence in the early stage of sepsis, initial high fever and chills, followed by skin lesions characterized by spots, papules, urticaria or scarlet fever-like rash, diagnosis is not difficult.

Differential diagnosis

Medicinal eruption is with a clear history of medication, with sudden onset, generally with symmetric generalized skin lesions characterized by erythema, papules, nodules, urticaria, scarlet fever-like or measles-like eruption, blisters, bullae, and even exfoliative dermatitis in severe cases, often with pruritus, but without hemorrhage, merely pustules and necrotic lesions, with mild systemic symptoms.

Allergic vasculitis is with pleomorphic skin lesions, severe pruritus, and mild systemic symptoms. Pathological examination shows swelling and occlusion of dermal capillary and small vascular endothelial cells, exudation, degeneration, and necrosis of fibrous protein in the vascular wall, and neutrophil infiltration in the vascular wall and around blood vessels.


Treatment

Systemic treatment can be performed as sepsis. Antibiotics can be administered.

Topical treatment is the same as those of pyodermia. Incision and drainage may be necessary if an abscess occurs.