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Muacevic A, Adler JR. Bilateral Cellulitis Presented As Lower-Extremity Pain Reported in a Chiropractic Clinic: A Case Report. Cureus 2023; 15:e35470. [PMID: 36860820 PMCID: PMC9968592 DOI: 10.7759/cureus.35470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/25/2023] [Indexed: 02/28/2023] Open
Abstract
Bilateral lower-extremity cellulitis is a rare but serious condition that can lead to long-term health complications if left untreated. Herein, we report a case of a 71-year-old obese male with a two-month history of lower-extremity pain and ankle swelling. Magnetic resonance imaging (MRI) revealed the presence of bilateral lower-extremity cellulitis, which was confirmed through blood culture by the patient's family doctor. The patient's initial presentation of musculoskeletal pain, limited mobility, and other features coupled with MRI findings served as indications for timely referral to the patient's family doctor for further evaluation and management. Chiropractors should be aware of the warning signs of infection and the importance of advanced imaging for diagnosing such cases. Early detection and prompt referral to a family doctor for care can help prevent long-term health complications associated with lower-extremity cellulitis.
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Affiliation(s)
| | - John R Adler
- Chiropractic Department, EC Healthcare, Hong Kong, HKG
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Zhou LL, Nurmohamed S, Au S, Beecker J, Green P, Robertson L, Mydlarski R. The Canadian Dermatology Association's Top Five Choosing Wisely Canada Recommendations. J Cutan Med Surg 2020; 24:461-467. [PMID: 32431167 DOI: 10.1177/1203475420928904] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
INTRODUCTION In this article, we present the Canadian Dermatology Association's (CDA) Choosing Wisely Canada (CWC) list of top "Five Things Physicians and Patients Should Question in Dermatology" and the evidence in support of each recommendation. METHODS Using a nominal technique, the CDA Working Group and Task Force generated an initial list based on literature review and expert consultation. After several rounds of list refinement via a modified Delphi process, a final list of recommendations was generated. These were approved by the CDA Board of Directors, presented at the CDA 93rd Annual Conference in 2018, and published by CWC in 2019. RESULTS The top five recommendations are as follows: (1) Don't routinely prescribe antibiotics for bilateral lower leg redness and swelling; (2) Don't routinely prescribe topical combination corticosteroid/antifungal products; (3) Don't routinely use topical antibiotics on a surgical wound; (4) Don't prescribe systemic antifungals without mycological confirmation of dermatophyte infection; and (5) Don't use oral antibiotics for acne vulgaris for more than 3 months without assessing efficacy. DISCUSSION This list of recommendations aims to encourage both physicians and patients to reevaluate ineffective, yet common, practices in treating dermatologic conditions. These recommendations represent actionable changes in practice, and therefore have considerable potential to enhance value-based care in dermatology. CONCLUSIONS This list was developed to identify tangible changes in practice within dermatology that may reduce inefficiencies, prevent potential patient harm, and improve care. Future advocacy work may include updates, feedback obtainment, and patient care handouts, to continue to promote value-based healthcare and best practices.
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Affiliation(s)
- Linghong Linda Zhou
- 8166 Department of Dermatology and Skin Science, University of British Columbia, Vancouver, Canada
| | - Sabrina Nurmohamed
- 2129 Division of Dermatology, Department of Medicine, University of Calgary, AB, Canada
| | - Sheila Au
- 8166 Department of Dermatology and Skin Science, University of British Columbia, Vancouver, Canada
| | - Jennifer Beecker
- 6363 Division of Dermatology, Department of Medicine, University of Ottawa, Ottawa Hospital Research Institute, ON, Canada
| | - Peter Green
- 12361 Division of Dermatology, Department of Medicine, Dalhousie University, Halifax, NS, Canada
| | - Lynne Robertson
- 2129 Division of Dermatology, Department of Medicine, University of Calgary, AB, Canada
| | - Regine Mydlarski
- 2129 Division of Dermatology, Department of Medicine, University of Calgary, AB, Canada
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da Costa Vieira RA, de Araujo Silva I, de Oliveira-Junior I, de Almeida Santos Yamashita ME, da Silva SRM. Unsuspected Stewart-Treves syndrome clinically mimicked by apparent bullous erysipelas and a systematic review of dermatological presentations of the classical Stewart-Treves syndrome. Cancer Rep (Hoboken) 2019; 2:e1143. [PMID: 32721135 DOI: 10.1002/cnr2.1143] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Revised: 09/19/2018] [Accepted: 09/27/2018] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND Stewart Treves-Syndrome (STS) was first characterized as angiosarcoma in the homolateral limb of a patient with breast cancer and lymphedema. Now, other conditions represent STS. It's a rare condition. The diagnosis is easier in the presence of single or multiple purple nodules. Even though other dermatological aspects have been reported, no study has grouped its characteristics. AIM Evaluate the dermatological characteristics of classical STS (c-STS). METHODS AND RESULTS We report a patient with chronic lymphedema with a history of recurrent erysipelas that rapidly developed multiple papules in the superior limb. It was initially diagnosed as bullous erysipelas, but unsatisfactory evolution led to biopsy, which demonstrated an unsuspected epithelioid angiosarcoma. We have also performed a review of dermatologic aspects of c-STS using PubMed and Lilacs databases. PICTOS methodology and PRISMA flow chart were considered. The main dermatological aspects associated with c-CTS were summarized. Using a systematic evaluation from 109 articles, 29 were selected and 44 patients were described to whom we added one case. The mean time with lymphedema was 10 years. Of the patients analyzed, 97.2% were female; 95.6% were submitted to radical mastectomy; 81.2% presented with multiple lesions, 67.4% of the lesions were reported as nodules or tumors, 53.4% were purple, 33.4% were associated with an ecchymotic halo, and 33.4% were ulcerated lesions. CONCLUSION When evaluating patients with chronic lymphedema with new dermatological abnormalities, clinical suspicion, or unfavorable evolution, the knowledge of clinical signs is important for diagnosis, and a biopsy must be considered. Papules associated with erythematous-wine color and bluish hematoma aspect must raise clinical suspicion.
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Affiliation(s)
| | - Igor de Araujo Silva
- Departamento de Mastologia e Reconstrução Mamária, Hospital de Câncer de Barretos, Barretos, SP, Brazil
| | - Idam de Oliveira-Junior
- Departamento de Mastologia e Reconstrução Mamária, Hospital de Câncer de Barretos, Barretos, SP, Brazil
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Singer S, Li DG, Gunasekera N, Okhovat JP, Vedak P, Weng C, Cohen J, Joyce C, Raff A, Kroshinsky D, Mostaghimi A. The ALT-70 cellulitis model maintains predictive value at 24 and 48 hours after presentation. J Am Acad Dermatol 2019; 81:1252-1256. [PMID: 30914341 DOI: 10.1016/j.jaad.2019.03.050] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2019] [Revised: 03/16/2019] [Accepted: 03/20/2019] [Indexed: 11/17/2022]
Abstract
BACKGROUND Cellulitis has many potential mimickers, and its misdiagnosis often leads to unnecessary hospitalizations and higher health care costs. The ALT-70 predictive model offers an objective tool to help differentiate between cellulitis and other clinically similar conditions at the time of initial emergency department (ED) presentation. OBJECTIVE To evaluate the performance of the ALT-70 predictive model at 24 and 48 hours following ED presentation. METHODS We performed a retrospective review of our prior cohort and expanded our data collection to include data at 24 and 48 hours after initial ED presentation. We compared classification measures for the ALT-70 at the time of initial ED presentation, 24 hours after presentation, and 48 hours after presentation. RESULTS There was a statistically significant difference in median ALT-70 score between patients with true cellulitis and those with mimickers of cellulitis at all time points. Sensitivity, specificity, positive predictive value, and negative predictive value of the ALT-70 score was similar across all 3 time points. LIMITATIONS Single-center design may reduce generalizability. CONCLUSION At 24 and 48 hours, the ALT-70 performed similarly to the way it performed at the time of initial ED presentation, allowing for its use in a wider array of clinical settings.
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Affiliation(s)
- Sean Singer
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - David G Li
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts; Tufts University School of Medicine, Boston, Massachusetts
| | - Nicole Gunasekera
- Department of Dermatology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Jean-Phillip Okhovat
- Department of Dermatology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Priyanka Vedak
- Department of Dermatology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Christina Weng
- Department of Dermatology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Jeffrey Cohen
- Ronald O. Perelman Department of Dermatology, NYU Langone Medical Center, New York University School of Medicine, New York, New York
| | | | - Adam Raff
- Department of Dermatology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Daniela Kroshinsky
- Department of Dermatology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Arash Mostaghimi
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
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Stevens DL, Bisno AL, Chambers HF, Dellinger EP, Goldstein EJC, Gorbach SL, Hirschmann JV, Kaplan SL, Montoya JG, Wade JC. Practice Guidelines for the Diagnosis and Management of Skin and Soft Tissue
Infections: 2014 Update by the Infectious Diseases Society of America. Clin Infect Dis 2014; 59:147-59. [DOI: 10.1093/cid/ciu296] [Citation(s) in RCA: 1187] [Impact Index Per Article: 118.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
A panel of national experts was convened by the Infectious Diseases Society of America (IDSA) to update the 2005 guidelines for the treatment of skin and soft tissue infections (SSTIs). The panel's recommendations were developed to be concordant with the recently published IDSA guidelines for the treatment of methicillin-resistant Staphylococcus aureus infections. The focus of this guideline is the diagnosis and appropriate treatment of diverse SSTIs ranging from minor superficial infections to life-threatening infections such as necrotizing fasciitis. In addition, because of an increasing number of immunocompromised hosts worldwide, the guideline addresses the wide array of SSTIs that occur in this population. These guidelines emphasize the importance of clinical skills in promptly diagnosing SSTIs, identifying the pathogen, and administering effective treatments in a timely fashion.
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Affiliation(s)
- Dennis L. Stevens
- Division of Infectious Diseases, Department of Veterans Affairs, Boise, Idaho
| | - Alan L. Bisno
- Medical Service, Miami Veterans Affairs Health Care System, Florida
| | | | | | - Ellie J. C. Goldstein
- University of California, Los Angeles, School of Medicine, and R. M. Alden Research Laboratory, Santa Monica, California
| | | | - Jan V. Hirschmann
- Medical Service, Puget Sound Veterans Affairs Medical Center, Seattle, Washington
| | - Sheldon L. Kaplan
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas
| | | | - James C. Wade
- Geisinger Health System, Geisinger Cancer Institute, Danville, Pennsylvania
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Vasuki S, Durgalakshmi J, Latha J. Cutaneous metastases presenting as genital ulcer disease. Indian J Sex Transm Dis AIDS 2014; 35:43-5. [PMID: 24958986 DOI: 10.4103/0253-7184.132422] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Cutaneous metastasis from an internal organ malignancy is rare and as, the presenting sign of malignancy is an uncommon phenomenon. Their presence, signals a poor prognosis. We report a case of 50-year-old female who was referred to sexually transmitted diseases - out patient department, with complaints of multiple genital ulcers to rule out sexually transmitted infections. After thorough evaluation, she was found to be a case of carcinoma cervix with metastatic squamous cell carcinomatous deposits on external genitalia. This case was unique because of relatively asymptomatic nature of internal malignancy and atypical presentation of carcinoma cervix as cutaneous metastasis.
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Affiliation(s)
- S Vasuki
- Department of Dermotology and STD, Thanjavur Medical College, Thanjavur, Tamil Nadu, India
| | - J Durgalakshmi
- Department of Dermotology and STD, Thanjavur Medical College, Thanjavur, Tamil Nadu, India
| | - J Latha
- Department of Dermotology and STD, Thanjavur Medical College, Thanjavur, Tamil Nadu, India
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Lower limb cellulitis and its mimics: part II. Conditions that simulate lower limb cellulitis. J Am Acad Dermatol 2012; 67:177.e1-9; quiz 185-6. [PMID: 22794816 DOI: 10.1016/j.jaad.2012.03.023] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2011] [Revised: 03/27/2012] [Accepted: 03/29/2012] [Indexed: 11/22/2022]
Abstract
Several common conditions can mimic cellulitis, creating a potential for misdiagnosis and incorrect management. The most common disorders mistaken for lower limb cellulitis include venous eczema, lipodermatosclerosis, irritant dermatitis, and lymphedema. The dermatologist is often consulted when a patient has failed to respond to therapy, and a thorough knowledge of the differential diagnosis is essential. This article focuses on entities that can mimic cellulitis, with an emphasis of elements of the history and physical examination that can help to distinguish between lower limb cellulitis and its simulators.
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Abstract
Cellulitis is an acute infection of the dermal and subcutaneous layers of the skin, often occurring after a local skin trauma. It is a common diagnosis in both inpatient and outpatient dermatology, as well as in the primary care setting. Cellulitis classically presents with erythema, swelling, warmth, and tenderness over the affected area. There are many other dermatologic diseases, which can present with similar findings, highlighting the need to consider a broad differential diagnosis. Some of the most common mimics of cellulitis include venous stasis dermatitis, contact dermatitis, deep vein thrombosis, and panniculitis. History, local characteristics of the affected area, systemic signs, laboratory tests, and, in some cases, skin biopsy can be helpful in confirming the correct diagnosis. Most patients can be treated as an outpatient with oral antibiotics, with dicloxacillin or cephalexin being the oral therapy of choice when methicillin-resistant Staphylococcus aureus is not a concern.
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Affiliation(s)
- Elizabeth Bailey
- Columbia University College of Physicians and Surgeons, New York, NY, USA
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Huang MN, Chang YC, Wu CH, Hsieh SC, Yu CL. The prognostic values of soft tissue sonography for adult cellulitis without pus or abscess formation. Intern Med J 2010; 39:841-4. [PMID: 20233245 DOI: 10.1111/j.1445-5994.2009.02053.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Abstract The current practice for cellulitis in diagnosis and treatment is mainly based on subjective clinical judgement without validated objective guidance. For patients with non-purulent cellulitis needing intravenous antibiotic treatment in hospital, we found soft tissue sonography performed around 4 days after initiation of antibiotics might have prognostic values. The patients with soft tissue sonographic pattern of subcutaneous thickening alone had shorter duration of antibiotic treatment and higher rate of early treatment response to antibiotics than those with the pattern of cobblestone appearance. Larger-scale research may be warranted to validate the prognostic roles of sonography in cellulitis management.
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Affiliation(s)
- M-N Huang
- Division of Allergy, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
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CEYHAN AM, BASAK PY, YILDIRIM M, AKKAYA VB. A case of cutaneous leishmaniasis presenting as facial cellulitis. J Dermatol 2010; 37:565-7. [DOI: 10.1111/j.1346-8138.2009.00760.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Cho WC, Pai YC, Hsiung Y, Choi WM. Cutaneous Tuberculosis Presenting as Necrotizing Fasciitis in an Elderly Patient. INT J GERONTOL 2008. [DOI: 10.1016/s1873-9598(08)70016-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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