CASE LEARNING OBJECTIVES
Recognize the signs and symptoms of skin and skin-structure infections
Understand the significant laboratory and imaging tests that should be performed to assist in the diagnosis and treatment of cellulitis
Develop an appropriate treatment regimen for cellulitis
Determine the appropriate monitoring parameters to evaluate therapeutic response to treatment of cellulitis
"My leg has been hurting for the last few days and now it is red."
History of Present Illness
Richard Rogers is a 54-year-old male who presents to his primary care provider complaining of a painful leg that has become red within the last day (Figure 81-1). Last week, he was hiking with his son and they both ended up with multiple lower and upper extremity abrasions secondary to tree brush. The abrasions have mostly healed, but he noticed his left calf became painful 2 days ago and now today it has become erythematous. He is worried that it may be related to a tick since he removed one from his dog the day of the hike. He denies any fever, chills, nausea, or vomiting.
°Cellulitis of leg after minor abrasion. (Adapted, with permission, from Usatine RP, Smith MA, Mayeaux Jr EJ, Chumley H, Tysinger J. The Color Atlas of Family Medicine. New York, McGraw-Hill, 2009, Fig 114-6.)
Peripheral artery disease (diagnosed 2 years ago)
s/p lower extremity stent (6.5 months ago)
Diastolic heart failure (ejection fraction 60% [0.60] measured 10 months ago)
Hyperlipidemia (diagnosed 10 years ago, last lipid panel 3 years ago)
HTN (diagnosed 13 years ago, controlled on medications)
Father deceased at the age of 70 years secondary to an MI. Mother is alive at the age of 82 years with hypothyroidism, HTN, and history of breast cancer. The patient is negative for thrombolic disorders.
The patient lives with his wife of 34 years. He has 3 adult children. He works as a lawyer.
The patient has a "few beers on the weekends." He smokes ½ ppd × 35 years. He denies illicit drug use.
Allergy/Intolerance/Adverse Event History
Codeine (unknown reaction)
Clopidogrel 75 mg PO daily
Simvastatin 20 mg PO daily
Lisinopril/HCTZ 20/12.5 mg PO daily
Naproxen 550 mg PO every 12 hours PRN pain