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Looking Beyond the Cell in Cellulitis

Maida, Vincent MD, MSc, BSc, CCFP(PC), FCFP, ABHPM; Cheung, Joyce T. W. MD, BSc, CCFP

Advances in Skin & Wound Care: May 2017 - Volume 30 - Issue 5 - p 209–212
doi: 10.1097/01.ASW.0000513333.85121.95
Features: Case Report

BACKGROUND: Patients with erythematous skin are likely to receive a diagnosis of cellulitis; however, the accuracy of this diagnosis is approximately only 33%. The diagnosis of cellulitis should be made only after a thorough evaluation of all possible differential diagnoses. Cellulitis may be a primary process (superficial spreading infective process involving only the epidermis and dermis) versus a secondary (reactive) process incited by a subcutaneous process, such as an abscess, tenosynovitis, necrotizing fasciitis, and osteomyelitis.

CASE PRESENTATION: A 50-year-old man was admitted to a general hospital with the diagnosis of cellulitis. He was initially treated with systemic antibiotics without improvement. Following consultation with a wound management physician, the patient received a diagnosis of a pretibial abscess and was treated with surgical evacuation and postoperative systemic antibiotic therapy guided by tissue cultures. A postoperative wound was successfully treated with inelastic compression therapy.

CONCLUSIONS: This case demonstrates the potential for misdiagnosis when evaluating erythematous skin. Furthermore, concluding that the erythema is due to a primary cellulitis may result in monotherapy with systemic antimicrobial agents. In such cases, making a correct diagnosis through a skillful and complete physical examination of the patient, coupled with appropriate investigations, will lead to the best possible outcome. A comprehensive treatment approach may include systemic antimicrobials, as well as surgical options and compression therapy.

Vincent Maida, MD, MSc, BSc, CCFP(PC), FCFP, ABHPM, is Associate Professor, Division of Palliative Care, University of Toronto; and Clinical Assistant Professor, Division of Palliative Care, McMaster University and Division of Palliative Medicine, William Osler Health System, Toronto, Ontario, Canada. Joyce T. W. Cheung, MD, BSc, CCFP, is a Palliative Medicine Consultant, Division of Palliative Medicine, William Osler Health System, Toronto, Ontario, Canada.

The authors disclose that they have no financial relationships related to this article. Submitted January 19, 2016; accepted March 24, 2016.

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