Distinguishing cellulitis from its mimics

Keller, Emily C; Tomecki, Kenneth J.; Alraies, M. Chadi

doi:10.3949/ccjm.79a.11121

Cited by 44 publications

(29 citation statements)

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“…Both LCV and cellulitis display a similar constellation of constitutional signs and symptoms, fever, and rash. One important difference in these conditions to emphasize is that cellulitis rarely, if ever, presents in a bilateral distribution while vasculitis typically does [ 22 ]. Similar to this case, the majority of cases presented with a purpuric or petechial rash, which histologically corresponds to blood extravasation from small blood vessels due to vessel necrosis.…”

Section: Discussionmentioning

confidence: 99%

Leukocytoclastic vasculitis as a rare dermatologic manifestation of Crohn’s disease mimicking cellulitis: a case report

et al. 2020

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Background Leukocytoclastic vasculitis (LCV) is an immune-complex mediated vasculitis characterized by neutrophilic inflammation and nuclear debris in post capillary venules. LCV is a rare dermatologic manifestation of Crohn’s disease (CD) and may occur with the onset of the disease or any time after the diagnosis including the period of exacerbation. Case presentation We present a 70 year old woman with history of psoriasis and treatment refractory CD requiring monoclonal antibody therapy with ustekinumab. One month prior to the current admission, she developed abdominal pain, worsening diarrhea and was diagnosed with CD exacerbation for which she was given ustekinumab. While her abdominal symptoms mildly improved with ustekinumab, she developed new bilateral lower extremity rash initially treated with levofloxacin for presumed cellulitis. The rash consisted of mild erythematous, non-scaling patches with scattered non-palpable petechiae on the lower extremities with subsequent involvement of abdomen, lower back and buttocks. Abdominal exam showed diffuse tenderness without mass, guarding or rebound while reminder of physical exam was unremarkable. Following the failure of antimicrobial therapy, she was diagnosed with LCV by skin biopsy. Complete work up was negative for infectious, malignant and inflammatory etiologies of LCV. Patient improved with increased dose of budesonide and subsequently continued to tolerate ustekinumab without recurrence of LCV. Discussion and conclusion LCV is a rare form of vasculitis and one of the rarest dermatologic manifestations of CD, appearing at any stage of the disease. LCV has been associated with autoimmune diseases, infections, specific drugs (levofloxacin, ustekinumab), and malignancy. Clinical presentation of LCV is variable and frequently mistaken for cellulitis. LCV should be considered in differential diagnosis of bilateral lower extremity rash in patients with CD after infectious, malignant and auto-immune/inflammatory etiologies are excluded. Unlike erythema nodosum (EN) and pyoderma gangrenosum (PG), LCV requires biopsy for diagnosis. Most patients respond well to steroids without scarring.

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Section: Discussionmentioning

confidence: 99%

Leukocytoclastic vasculitis as a rare dermatologic manifestation of Crohn’s disease mimicking cellulitis: a case report

et al. 2020

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“…We propose that lower extremity cellulitis is seldom bilateral 3. The differential diagnosis of bilateral leg lesions includes stasis-dermatitis, lipo-dermatosclerosis, lymphoedema, chronic venous insufficiency, erythroderma, vascular lesions (such as Kaposi's sarcoma) and numerous other entities 4.…”

Section: Discussionmentioning

confidence: 99%

Bilateral cellulitis

Batra¹,

Baras²

2015

BMJ Case Reports

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We present a case of bilateral lesions in a 50-year-old man, which were on first impression mistaken for and initially treated as bilateral cellulitis. We propose that bilateral cellulitis, as opposed to unilateral, is rare and that other aetiologies should be considered in evaluating a patient with bilateral lesions. The differential diagnosis includes stasis-dermatitis, lipodermatosclerosis, lymphoedema and vascular lesions such as Kaposi sarcoma, as was identified in this case. Early consultation with dermatology and biopsy in unclear cases mitigates the unnecessary use of prolonged antibiotics, antibiotic resistance andClostridium difficileinfections. HIV testing is an essential screening test in all adults who present with non-specific viral symptoms and rash.

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“…antibiotics, Balsam of Peru, nickel, cobalt and preservatives), with a greater propensity to develop allergic reactions under conditions of chronic inflammation and accumulation of Langerhans cells in the epidermis. Patients frequently present with positive patch test results to antibiotics, so the topical use of such drugs is not indicated [35].…”

Section: Stasis Dermatitismentioning

confidence: 99%

Chronic venous insufficiency – epidemiology, classification and clinical picture. Diagnostic and therapeutic recommendations of the Polish Dermatological Society. Part I

Bowszyc‐Dmochowska¹,

Kapińska-Mrowiecka²,

Kaszuba³

et al. 2018

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Chronic venous insufficiency is an important clinical problem in daily dermatological practice. The disease is caused by impaired function of the venous system in the lower limbs and affects approximately 60% of the adult population. The article discusses the key epidemiological factors of chronic venous insufficiency, the updated classification and the clinical features of skin lesions developing in the course of the disease.

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Distinguishing cellulitis from its mimics

Cited by 44 publications

References 0 publications

Leukocytoclastic vasculitis as a rare dermatologic manifestation of Crohn’s disease mimicking cellulitis: a case report

Leukocytoclastic vasculitis as a rare dermatologic manifestation of Crohn’s disease mimicking cellulitis: a case report

Bilateral cellulitis

Chronic venous insufficiency – epidemiology, classification and clinical picture. Diagnostic and therapeutic recommendations of the Polish Dermatological Society. Part I

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