Cellulitis: The Daily PANCE Blueprint

Cellulitis: The Daily PANCE Blueprint

A 42-year-old male with a history of diabetes presents the ER with a “bad rash” on his left thigh. He said he had previously gotten a bug bite there. He is febrile (102.2F), tachycardic (110 bpm), and hypotensive (80/50 mmHg). On physical exam, you notice a 2-inch erythematous circular lesion that is warm to the touch. Which of the following is the best next step in the management of this patient?

A. Initiate IV antibiotics and fluids
B. Surgical consult for amputation
C. Outpatient dermatology referral
D. Order venous ultrasound of the leg
E. Send home on oral antibiotics

Answer and topic summary

The answer is A. Initiate IV antibiotics and fluids

This patient has a severe case of cellulitis and sepsis. The best next step is to initiate intravenous antibiotics and fluids. A broad-spectrum antibiotic (like cefepime) plus coverage for MRSA (vancomycin) would be appropriate.

The most common cause of cellulitis is Group A beta hemolytic Streptococcus pyogenes. What differentiates cellulitis from erysipelas is that erysipelas is more well-defined. Antibiotic options for more mild cellulitis cases include Bactrim, clindamycin, and Keflex.

It’s important to keep in mind that events don’t happen in a vacuum — the bug bite led to cellulitis, and the patient’s body responded to the cutaneous infection in a complex and dysregulated way (i.e. sepsis), eventually leading to hypotension and instability.

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Smarty PANCE Content Blueprint Review:

Covered under ⇒ PANCE Blueprint DermatologyDermatologic Infectious diseasesBacterial InfectionsCellulitis

Also covered as part of the Family Medicine EOR, Emergency Medicine EOR, and General Surgery EOR topic list