Skin and soft tissue infections represent a broad spectrum of diseases, ranging from relatively mild to life-threatening conditions. Among the most dangerous forms is phlegmon—an acute, diffuse purulent inflammation that can affect various tissues of the body, including the skin, subcutaneous tissue, and internal organs. Timely diagnosis and appropriate treatment are critical to preventing serious complications and saving the patient's life.
What is Phlegmon?
Phlegmon is a severe infectious disease characterized by diffuse purulent inflammation that lacks clear boundaries, unlike an abscess. It rapidly spreads through connective tissue, affecting deep layers and adjacent structures. Although the cited scientific sources describe cases of phlegmonous involvement of internal organs such as the stomach or intestines, the principles of severity, diagnostic complexity, and the necessity of emergency treatment also apply to phlegmons of the skin and soft tissues [2, 6].
For example, phlegmonous gastritis is a rare but potentially fatal infection of the stomach wall. It is difficult to diagnose due to non-specific symptoms, but early clinical suspicion and timely therapeutic intervention can be lifesaving, especially in immunocompromised patients [2]. Similarly, phlegmonous processes can develop around internal organs, as in the case of intestinal perforation caused by lymphoma, which led to the formation of a phlegmonous collection eroding into the urinary bladder [6]. These examples emphasize the destructive nature of phlegmon and its capacity for rapid spread and involvement of neighboring tissues.
Risks and Course Features of Severe Infections
Phlegmon and other severe infections pose a particular danger to immunocompromised patients. Conditions such as chemotherapy-induced neutropenia (decreased neutrophil count) or general immunosuppression significantly increase the risk of developing aggressive infections [2]. In such patients, infectious processes can progress extremely rapidly, leading to shock and other life-threatening conditions. For instance, a case of phlegmonous gastritis in a patient with chemotherapy-induced neutropenia demonstrates how quickly a severe condition requiring immediate response can develop [2].
Diabetes is also a major risk factor for developing severe infections. Although one of the sources describes a case of rhino-orbital-cerebral mucormycosis (an aggressive fungal infection) in an adolescent with diabetic ketoacidosis, this highlights how type 1 diabetes can contribute to the rapid progression of infections associated with high mortality and disability [4]. These findings indicate the need for heightened vigilance and aggressive treatment of infections in individuals with chronic conditions and compromised immunity.
Variety of Cutaneous Manifestations of Bacterial Infections
The skin can be affected by various bacterial infections that manifest in different ways. In addition to phlegmon, other forms exist that may indicate a systemic disease. For example, disseminated gonococcal infection, which is a complication of untreated urogenital gonorrhea, can manifest on the skin. In one case, an 18-year-old female with fever and joint pain developed hemorrhagic pustules, petechiae, and purpuric lesions, confirmed as a disseminated gonococcal infection [7].
These cutaneous manifestations are an important diagnostic sign indicating the systemic spread of the infection. Untimely diagnosis and lack of treatment for urogenital gonorrhea increase the risk of disseminated infection, emphasizing the importance of early detection and therapy for all forms of bacterial infections [7].
Diagnostics and the Importance of Early Intervention
The diagnosis of phlegmon and other severe infections is often complicated by the non-specificity of early symptoms. However, as clinical cases show, high clinical suspicion plays a key role [2]. Imaging methods such as computed tomography (CT) are used to diagnose internal phlegmons, which can reveal diffuse thickening of organ walls [2, 6]. In the case of phlegmonous gastritis, esophagogastroduodenoscopy (EGD) allowed the detection of extensive mucosal damage, serving as the basis for the immediate initiation of empiric antimicrobial therapy [2].
Early detection and the immediate initiation of treatment are decisive factors for a favorable outcome. A delay in diagnosis or treatment, especially in immunocompromised patients, can lead to rapid disease progression, shock, multiple organ failure, and death [2, 4].
Approaches to Treating Severe Infections
The treatment of severe infections such as phlegmon requires a comprehensive and aggressive approach. The foundation is the immediate administration of empiric antimicrobial therapy, meaning broad-spectrum antibiotics, pending the results of bacteriological cultures [2]. This allows the fight against the infection to begin without delay. In the case of phlegmonous gastritis, the patient responded well to conservative treatment with clinical and endoscopic improvement following the timely administration of antibiotics [2].
In complex cases, especially in patients with comorbidities or compromised immunity, a multidisciplinary approach is essential. This includes collaboration among various specialists, pharmacological assessment, optimization of the antimicrobial regimen, and drug therapy monitoring [4]. For example, in mucormycosis in a patient with diabetic ketoacidosis, clinical pharmacists played a key role in optimizing antifungal therapy [4]. Such an approach ensures the most effective and safe treatment, taking into account all individual patient characteristics and the complexity of the infectious process.
Sources
- 1. Advances in current and emerging treatments for complex cutaneous mucinoses with significant morbidity and therapeutic complexity: A review. https://pubmed.ncbi.nlm.nih.gov/42525592/
- 2. Phlegmonous gastritis in chemotherapy-related neutropenia with endoscopic findings prompting early therapeutic intervention. https://pubmed.ncbi.nlm.nih.gov/41730628/
- 3. JAK inhibitors for the treatment of pyoderma gangrenosum and Sweet's syndrome: A systematic review of published case reports. https://pubmed.ncbi.nlm.nih.gov/42472066/
- 4. Case Report: Adolescent diabetic ketoacidosis complicated by rhino-orbital-cerebral mucormycosis. https://pubmed.ncbi.nlm.nih.gov/42524461/
- 5. What is new in the management of eczema. https://pubmed.ncbi.nlm.nih.gov/29050445/
- 6. Chemotherapy-naïve jejunal lymphoma with fistulization into the urinary bladder. https://pubmed.ncbi.nlm.nih.gov/41179038/
- 7. Cutaneous manifestations of disseminated gonococcal infection. https://pubmed.ncbi.nlm.nih.gov/28329470/
- 8. Management of chronic hand and foot eczema. An Australian/New Zealand clinical review. https://pubmed.ncbi.nlm.nih.gov/32776537/
Disclaimer: The information provided in this article is for reference purposes only and cannot replace professional consultation, diagnosis, or treatment provided by a qualified medical specialist. Always consult a physician for medical care and recommendations.