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INTRODUCTION

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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

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PATIENT PRESENTATION

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Chief Complaint

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"My leg has been hurting for the last few days and now it is red."

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History of Present Illness

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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.

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FIGURE 81-1.

°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.)

Graphic Jump Location
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Past Medical History

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Peripheral artery disease (diagnosed 2 years ago)

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s/p lower extremity stent (6.5 months ago)

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Diastolic heart failure (ejection fraction 60% [0.60] measured 10 months ago)

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Hyperlipidemia (diagnosed 10 years ago, last lipid panel 3 years ago)

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HTN (diagnosed 13 years ago, controlled on medications)

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Family History

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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.

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Social/Work History

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The patient lives with his wife of 34 years. He has 3 adult children. He works as a lawyer.

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Tobacco/Alcohol/Substance Use

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The patient has a "few beers on the weekends." He smokes ½ ppd × 35 years. He denies illicit drug use.

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Allergy/Intolerance/Adverse Event History

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Codeine (unknown reaction)

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Medication History

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Clopidogrel 75 mg PO daily

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Simvastatin 20 mg PO daily

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Lisinopril/HCTZ 20/12.5 mg PO daily

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Aspirin 81 mg PO daily

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Naproxen 550 mg PO every 12 hours PRN pain

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Review of Systems

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