H.P.I. The patient is a 70 yo woman who has had ~ 10 episodes of a cellulitis-like picture of her legs over the past ten years. She has never had fever or constitutional signs. The process can affect one or both lower extremities. I saw her in 2001 for this and then she was referred by the emergency room yesterday with the same picture. It began with a fall two days ago. She hit her hip -- was in pain and took ibuprofen before this episode. She said she does not recall taking this before other episodes.
O/E: Patchy, fiery erythema of left lower extremity. Very mild erythems of right lower leg (mostly around the ankle).
Clinical Photos:
Labs: Biopsy obtained and CBC ordered
Diagnosis: Is this an atypical cellulitis, or toxic erythema secondary to and NSAID?
Discussion: If the patient remains afebrile and wbc is normal, I'd be inclined to just watch and wait.
This is toxic erythema rather than reccurent cellulitis as the patient is healthy and no features of bacterial toxicity .This is will be confirmed by the results of biopsy.
ReplyDeletekhalifa sharquie
Looks like cellulitis to me.More often patients don't show any consititional symptoms and they are afebrile.
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