Cellulitis or Necrotizing Faciitis? - USMLE Forums
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  #1  
Old 03-31-2012
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Skin Cellulitis or Necrotizing Faciitis?

A 30-year-old obese woman comes to the emergency department complaining of four days of progressive
pain, swelling and redness of her right leg. She has no obvious trauma or insect bites. She does not use
tobacco, alcohol or illicit drugs. Her temperature is 38 TC ( 1 03 .O.F), pulse is 1 06/min, and blood pressure is
130/80 mmHg. Her right calf is swollen, erythematous, and extremely tender and warm to the touch over a 6
x 3 em region. There is a tender, palpable mass in her right groin. There is no overlying crepitus and no
bullae are seen. The toe webs are fissured and macerated. Laboratory studies show:
Complete blood count 222,000/mm3

Hemoglobin 14.0 g/L

Leukocyte count 14,500/mm3

Neutrophils86%

Lymphocytes14%

Which of the following is the most likely cause of her current leg condition?
A. Cellulitis
B. Arterial thrombosis
C. Deep venous thrombosis
D. Necrotizing fascitis
E. Ruptured Baker's cyst
F. Erythema nodosum
G. Erysipeloid
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  #2  
Old 03-31-2012
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i really dont know what the answer is but i will go with cellulitis based on this info i found and have pasted on this page:


However, cellulitis frequently occurs in areas where no apparent injury exists. This is common in dry and irritated skin where microscopic breaks allow penetration of bacteria. Patients with toe web intertrigo and/or tinea pedis and those with lymphatic obstruction, venous insufficiency, pressure ulcers, and obesity are particularly vulnerable to recurrent episodes of cellulitis.
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Old 03-31-2012
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cellulitis is infection of dermis and subcutaneous tissue without necrosis...treatment is ox/clox/diclox and naf or first generation cephalo like cefazolin..if mrsa...vanco

necrotising fascitis is infection of subcutaneous and depper tissue reaching upto fascia and causing extensive necrosis.....look for crepitus or air bullae in question..........treatment surgical debridgement and antibiotic b lactam+b lactamase or penicillin and clindamycin.....
clinically pain is out of proportion to superficial appearance . looks like its cellulitis due to absence of crepitus. i think cellulits. not sure though.
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Old 03-31-2012
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I would say cellulitis as well - no bullae or crepitus, well-defined area of tenderness. (Did the weird temperature conversion bother anyone else? 38 C is 100.4 F...)
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  #5  
Old 04-02-2012
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Default Cellulitis

The case seems to have features of both cellulitis and nec fascitis but if I were to choose one, I would go for cellulitis because of absence of crepitus or bullae.

Extreme pain/tenderness is more in keeping with nec facitis though
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Old 04-02-2012
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cellulitus
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Old 04-02-2012
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necrotizing faciitis allways is with crepitation caouse of anaerobic bacteria activation so the wright answer is cellulitis
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Old 04-02-2012
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Default cellulitis

ANS: Cellulitis

The mass in the right quardrant could be due to ulcerative colitis, with the associated skin features of erythema nodusm that can become septic. Just a thought not sure.
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Old 04-03-2012
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Default A. Cellulitis

A. Cellulitis
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Old 04-23-2012
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How dod you rule out Erysipeloid?
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Old 04-23-2012
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Quote:
Originally Posted by Teresa View Post
How dod you rule out Erysipeloid?
"Swollen", so more than a dermatitis
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Old 04-23-2012
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Quote:
Originally Posted by Teresa View Post
How dod you rule out Erysipeloid?
No h/o animal (product) contact.
Cellulitis is the correct answer since there is painful inguinal lymphadenopathy.

Quote:
Predisposing conditions for cellulitis include insect or spider bite, blistering, animal bite, tattoos, pruritic (itchy) skin rash, recent surgery, athlete's foot, dry skin, eczema, injecting drugs (especially subcutaneous or intramuscular injection or where an attempted intravenous injection "misses" or blows the vein), pregnancy, diabetes and obesity, which can affect circulation, as well as burns and boils, though there is debate as to whether minor foot lesions contribute.
Cellulitis in the lower leg is characterized by signs and symptoms similar to those of a deep vein thrombosis, such as warmth, pain and swelling (inflammation). This reddened skin or rash may signal a deeper, more serious infection of the inner layers of skin. Once below the skin, the bacteria can spread rapidly, entering the lymph nodes and the bloodstream and spreading throughout the body.

Last edited by Novobiocin; 04-23-2012 at 06:42 PM.
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