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Phlegmon: Causes, Symptoms and Treatment

A phlegmon is an acute, diffuse bacterial infection of the subcutaneous tissue and fascia, characterized by spreading redness, swelling, warmth, and pain.

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Things worth knowing about "Phlegmon"

A phlegmon is an acute, diffuse bacterial infection of the subcutaneous tissue and fascia, characterized by spreading redness, swelling, warmth, and pain.

What is a Phlegmon?

A phlegmon is an acute, rapidly spreading infection of the connective tissue, primarily affecting the subcutaneous fat (hypodermis) and the fasciae. Unlike an abscess, where pus is contained within a defined capsule, a phlegmon spreads diffusely along tissue planes and can affect large areas of the body. It is a medical condition that requires prompt treatment to prevent serious complications.

Causes

Phlegmons are most commonly caused by bacteria that enter the tissue through small skin injuries, wounds, or insect bites. The most frequent pathogens include:

Streptococcus pyogenes (Group A streptococci)
Staphylococcus aureus, including methicillin-resistant strains (MRSA)
Less commonly: Gram-negative bacteria or anaerobic organisms

Risk factors include a weakened immune system, diabetes mellitus, lymphedema, chronic venous insufficiency, obesity, and pre-existing skin conditions.

Symptoms

A phlegmon typically presents with the classic signs of inflammation:

Redness (Rubor): widespread reddening of the affected skin area
Warmth (Calor): increased local skin temperature
Swelling (Tumor): tissue swelling and tension
Pain (Dolor): tenderness and pain at the affected site
Loss of function (Functio laesa): restricted movement of the affected area

Systemic symptoms may also occur, including fever, chills, nausea, and swollen lymph nodes. In severe cases, the infection can spread to the bloodstream, leading to sepsis.

Diagnosis

The diagnosis of a phlegmon is primarily clinical, based on the physical examination and the typical signs of infection. The following investigations are used to confirm the diagnosis and assess its extent:

Blood tests: Elevated inflammatory markers such as CRP, white blood cell count, and procalcitonin indicate infection.
Blood cultures: To detect possible bacteremia (bacteria in the bloodstream).
Ultrasound: To differentiate a phlegmon from an abscess and assess the depth of tissue involvement.
MRI or CT scan: Used when deep infection is suspected (e.g., necrotizing fasciitis) or to map the extent of spread.
Wound swab or biopsy: For pathogen identification and antibiotic sensitivity testing.

Treatment

Antibiotic Therapy

The primary treatment for a phlegmon is antibiotic therapy. Mild cases may be managed with oral antibiotics such as amoxicillin-clavulanate or cefalexin. Severe or rapidly spreading infections require hospital admission with intravenous antibiotics (e.g., penicillin, clindamycin, or vancomycin in cases of suspected MRSA).

Surgical Treatment

If an accompanying abscess is present or the infection does not respond to antibiotics, surgical intervention with incision and drainage of the infected area becomes necessary. In cases of necrotizing fasciitis, a particularly severe form of the condition, immediate surgical debridement (removal of dead tissue) is life-saving.

Supportive Measures

Immobilization and elevation of the affected limb
Adequate fluid intake
Pain management
Close clinical monitoring and follow-up

References

Eron LJ et al. - Managing skin and soft tissue infections: expert panel recommendations on key decision points. Journal of Antimicrobial Chemotherapy, 2003.
Stevens DL et al. - Practice Guidelines for the Diagnosis and Management of Skin and Soft Tissue Infections. Clinical Infectious Diseases, 2014.
Longo DL et al. (eds.) - Harrison's Principles of Internal Medicine, 21st edition. McGraw-Hill Education, 2022.

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