Recurrent cellulitis after coronary bypass surgery. Association with superficial fungal infection in saphenous venectomy limbs

Abstract

Certain patients who have undergone coronary artery bypass grafts suffer from episodes of acute cellulitis, often repeatedly, in the saphenous vein donor extremity. Nine patients with this entity, 5 of whom suffered recurrent attacks (range, 2 to > 20), are described. The mean interval between surgery and the initial bout of cellulitis was 15 mo. (range, 2-46 mo.). A characteristic clinical syndrome was present in the majority of patients that included the abrupt onset of chills, followed by fever (generally > 38.8.degree. C), prostration and obvious cellulitis. Seven patients also suffered from tinea pedis; in 2 instances, measures to control the dermatophytosis were instituted and attacks ceased. The pathogenesis of the entity may involve complex interactions between fungal and bacterial agents. Factors such as direct bacterial infection, hypersensitivity to streptococcal exotoxins and intradermal reactions to dermatophytes are probably involved in varying combinations.