Erysipelas as a Superinfection of an Oral Lymphangioma A n 11-year-old girl presented to the dermatologic clinic complaining of hemifacial inflammatory swelling and redness appearing after 6 days of ongoing fever. Phys- ical evaluation showed a well-defined erythematous patch with palpable slightly raised borders on the right cheek, nose, and right one-half of the upper lip. The area involved was tender to palpation with ipsilateral cervical lymphadenopathy. During examination of the oral cavity, several hemor- rhagic and transluminant vesicles were observed on the mu- cosa of the right cheek and nasal cavity. The parents informed us that the lymphatic malformation was observed during the first year of life. From cutaneous swab, a group A Streptococcus pyogenes was isolated. The patient was success- fully treated with intravenous amoxicillin clavulanate and topical mupirocin. This led us to diagnose congenital microcystic lymphan- gioma of the oral cavity complicated by erysipelas. Lymphatic malformations are rare vascular anomalies composed of in- terconnected lymphatic channels. They can be macrocystic, microcystic, or mixed, and may combine with capillary or venous malformations. Microcystic lymphangiomas present as flesh-colored translucent vesicles and hemorrhagic changes may occur in some of the lesions. The head/neck is the most frequent location (60%), and in childhood they may compress adjacent structures causing visible deformity, pain, bleeding, and obstruction, and are prone to repeated bacterial infections. Erysipelas is an inflammatory skin infection affecting the epidermis and superficial dermis usually caused by group A Streptococcus beta-hemolyticus. It is more common in older and immunocompromised patients, whereas it rarely occurs in neonates and small children. Predisposing factors are disruption of the skin barrier, inflammation, pre-existing skin infection, and lymphatic obstruction. In the case of facial erysipelas, it is also important to examine the oral cavity looking for a microcystic lymphangioma. n Iria Neri, MD Division of Dermatology Department of Specialised, Experimental, and Diagnostic Medicine Francesca Montanari, MD Pediatric Unit Department of Medical and Surgical Sciences Carlotta Baraldi, MD Lorenza Ricci, MD Annalisa Patrizi, MD Division of Dermatology Department of Specialised, Experimental, and Diagnostic Medicine S. Orsola- Malpighi Hospital University of Bologna Bologna, Italy References available at www.jpeds.com Figure 1. Erythematous patch with palpable slightly raised borders on the right cheek, nose, and right half of the upper lip. Figure 2. Several “frog spawn” vesicles on the right jugal mucosa. J Pediatr 2014;-:---. 0022-3476/$ - see front matter. Copyright ª 2014 Elsevier Inc. All rights reserved. http://dx.doi.org/10.1016/j.jpeds.2014.03.044 1