Recurrent Cellulitis After Saphenous Venectomy for Coronary Bypass Surgery

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Abstract
We describe a previously unreported complication of coronary artery bypass grafting, recurrent cellulitis. Five patients had 20 episodes of acute cellulitis, each occurring in the lower extremity in which saphenous venectomy had been done. The cases were striking because the patients presented with high fever and considerable systemic toxicity. The appearance of the lesions, presence in one case of obvious associated lymphangitis, and prompt response in three instances to therapy with penicillin alone all suggest group A streptococcal infection. In one case, a beta-hemolytic, bacitracin-susceptible Streptococcus strain was isolated from the lesion. The pathogenesis of this syndrome remains obscure but, based on our understanding of postsurgical erysipelas, this cellulitis likely results from the interplay of several factors, including local compromise of lymphatic drainage, direct bacterial invasion, and acquired hypersensitivity to streptococcal exotoxins.