Infectious Diseases Case of the Month
Post Operative Cellulitis

A 76 y.o. white female was admitted to Munson Medical Center because of a blistering cellulitis of her right hand after undergoing carpal tunnel surgery the day before.

Within hours of her outpatient surgery the preceding day she had noted the onset of swelling beneath her surgical dressing and had experienced intense pruritus. When the dressing was removed by her surgeon on the day of admission to the hospital, there was obvious swelling and erythema of the palmar hand and distal forearm with large bullae and vesicles (see photos at left). The process extended to the dorsal interdigital webspace between the first and second fingers but otherwise largely spared the dorsum of the hand. The involved area was painful and pruritic, but the patient did not feel ill generally and was afebrile.

She had previously been in good health. Her past medical history was notable for breast cancer and hypertension. She was fond of seafood and visiting her Asian born grandchildren in Kansas City. Approximately three months prior to her current admission she had experienced a similar episode of rapid onset swelling and erythema after surgery to release a trigger thumb on the same hand. On that occasion her problem did not respond to outpatient cephalexin, then clindamycin. In the hospital she was treated with parenteral ceftriaxone and there was eventual resolution. Wound and blood cultures were negative.

Laboratory evaluation of the second (current) episode included WBC 9.7, Hgb 15.7, and Plts 257. Aspirate of fluid from the large bullae on her palm and two blood cultures were submitted to the microbiology lab before she was begun on IV antibiotics.



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