Cutaneous sepsis caused the death of Erasmo Carlos, but it came from a bigger picture

The death of Erasmo Carlos, 81, this Tuesday (22nd), was attributed by the team at the Barra D’Or hospital, in Rio, to “panniculitis complicated by sepsis of cutaneous origin”. The announcement was made by the artist’s family and team through the singer’s social networks, whose wake will be closed to family and close friends.

At first, the loss was attributed to an edemigenic syndrome, an accumulation of fluids that leaves edema in the body and which is actually just one of the symptoms of a more serious condition. Panniculitis, in turn, is a rare disease, characterized by an inflammation of the fat layer that is located under the skin.

Doctor Natan Chehter, a geriatrician member of the Brazilian Society of Geriatrics and Gerontology and the Beneficência Portuguesa Hospital of São Paulo, says that the mechanisms that cause panniculitis are still poorly understood. “The reasons, in general, are related to some autoimmune disease or secondary reaction such as cancer, tuberculosis or diseases in which the immune system ends up reacting inappropriately”, says the geriatrician.

Panniculitis can be triggered by external aggressors such as cancer or tuberculosis, but also by the reaction of the person’s own antibodies given by problems such as Crohn’s disease or some vasculitis. “Panniculitis has to do with the deregulation of the immune system. We know that some nodules form on the skin and that, depending on the subtype of the disease, it can generate more serious cases of skin infection”, points out Chehter.

Tissue necrosis leads to the appearance of ulcers and skin lesions and, as in Erasmo’s case, it can evolve into a generalized infection, the so-called sepsis, capable of leading the patient to organ failure, among other symptoms. The disease that led Erasmo to hospitalization and may have caused sepsis of cutaneous origin, however, was not reported.

Recently awarded the Latin Grammy for best rock or alternative music album in Portuguese in 2022 for the album “O Futuro Pertence à… Jovem Guarda”, on the 17th, Erasmo had been hospitalized since October.

Earlier this month, it postponed two US shows (one on the 4th in Orlando, another on the 10th in Miami).

The note from the medical team released after the singer’s death states that he had been hospitalized since the 2nd due to a severe case of panniculitis.

Geriatrician and intensivist Carla Núbia Nunes Borges, professor at the Catholic University of Pernambuco, says that the cause of panniculitis has been associated with autoimmune pathologies, but also with trauma, surgery or neoplasms. “Some causes are simple and others are manifestations of serious illness. The typical picture is sensitive and erythematous lumps [vermelhos] most common in arms and legs,” she says.

Panniculitis also derives from systemic lupus erythematosus (SLE), inflammatory bowel disease, polyarteritis nodosa and from situations of infection and injury. There is no direct prevention and, according to the professor, any lesion with these characteristics should be investigated with a biopsy to confirm subcutaneous inflammation.

“The patient should seek immediate medical evaluation for diagnosis and treatment. Treatment involves assessing the affected site, based on the clinical condition. There is no specific treatment, and an arsenal of medications can be used to relieve pain, inflammation and infection”, reports Borges.

Chehter, in turn, points out that the singer’s case derives from an already aggravated condition and that, in general, anyone looking for some form of prevention needs to focus on health. The swellings of the edemigenic syndrome, for example, which are quite uncomfortable, are the final stage, but derive from a silent picture of vascular, heart, liver or kidney diseases.

“If you’re diabetic, cardiac, obese and smoke, you have the complete package. You have to see a doctor before you have symptoms. There are people who say ‘I have diabetes and high cholesterol and I don’t feel anything’, that’s because the time she feel, it’s past the point of treating before having a problem”, reinforces the doctor.