Review Question - QID 103600

This patient is presenting with erythema of his lower extremity with edema/cobblestoning without a fluid collection which is suggestive of cellulitis. Cellulitis should be treated with oral antibiotics such as cephalexin.

Cellulitis is commonly characterized by inflammation of the skin and subcutaneous tissues usually in response to an acute infection. A breach in the skin is often the initial inciting factor. Clinically, cellulitis presents as the acute and progressive onset of a red, warm, and edematous area of skin. The diagnosis is made clinically; however, ultrasound can show edema and cobblestoning. The treatment of cellulitis is an oral antibiotic that covers staphylococcus and streptococcus such as cephalexin.

Figure A demonstrates what an initial physical exam of a patient with cellulitis may look like with mild erythema without well-defined borders. Figure B is an ultrasound demonstrating edema and cobblestoning which is suggestive of cellulitis.

Incorrect Answers:
Answer 2: Heparin is indicated in the management of a DVT which presents with an observed clot in the vein and a non-compressible vein.

Answer 3: Incision and drainage are indicated in the management of an abscess which would present with a tender/fluctuant mass and an ultrasound demonstrating a focal fluid collection.

Answers 4-5: Piperacillin-tazobactam and vancomycin are broad-spectrum antibiotics which would be given in necrotizing fasciitis (in addition to surgical debridement) which presents with a red, hot, and inflamed rash with crepitus, fever, and a rapidly spreading/progressing condition.

Bullet Summary:
Cellulitis can be diagnosed clinically and treated with oral antibiotics.