CLL Advocates Newsletter Issue 11

Dear Friends of CLLANZ

Skin infection (cellulitis) and CLL – a cautionary tale

Cellulitis is an infection of the skin, most commonly of the legs. It is usually due to bacteria. It commonly arises when the integrity of the skin is breached by a penetrating injury, often in the context of a pre-existing condition, such as diabetes, and conditions where immunity is impaired, such as CLL.

Cellulitis is the second most common primary site causing severe infection in patients with CLL (lower respiratory tract infections are the most common). It is often associated with sepsis/septicemia; when this happens, mortality is about 25% one month on from the episode of cellulitis. So awareness of what cellulitis is, and prompt antibiotic treatment thereof can save lives.

Professionally and theoretically, I have always been concerned about the risks of cellulitis, but in practice I’ve always led a physically active lifestyle, acquiring numerous skin injuries in the process. So it’s perhaps surprising that I hadn’t ever got cellulitis.

That all changed recently, when I had a penetrating injury of my left leg by a stick. Twelve hours later, I awoke in the night feeling very unwell, with a red, swollen, and painful leg. I was admitted to hospital for five days of intravenous antibiotics (blood cultures were positive for E. coli), with a good response, and was sent home on oral antibiotics.

About a week later, the infection recurred, despite oral antibiotics, and I again felt very unwell. I was readmitted to hospital, the first few days of this period being in ICU/HDU because of my level of unwellness. Blood cultures were again positive for E. coli. This time, I was an inpatient for a total of fifteen days; IV antibiotics for all that time, then a further week of IV antibiotics as an outpatient, after discharge. This seems to have done the trick, and I am currently back to where I was pre-leg injury, health-wise.

So, for those with CLL, please look after your skin, particularly on your legs. Wear gumboots and other protective clothing when in the outdoors, seek prompt medical advice/treatment for any skin injuries, and keep a careful eye on such injuries. Sepsis can be serious/fatal quite quickly.

I for one have certainly adopted a change in approach to looking after my skin as a consequence of this episode.

Best wishes

Neil Graham