Bilateral cellulitis

Abstract

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.

The red leg dilemma: a scoping review of the challenges of diagnosing lower‐limb cellulitis

“…Next, 533 full‐text articles were assessed for eligibility and 71 were included for data extraction (Fig. ) . Nine papers were foreign‐language texts: six French, two Spanish and one Turkish.…”

“…Ten patients (11%) were later diagnosed with a malignancy, including one case of metastatic malignant melanoma and a neonatal case with kaposiform haemangioendothelioma…”

A case of progressive lower leg edema

“…Intravenous vancomycin is empiric treatment for cellulitis in a patient at risk for methicillin-resistant Staphylococcus aureus (HIV positive status) 1 . Bilateral lower leg cellulitis is rare, and our patient does not have other stigmata of acute infections, such as fever, pain, or malaise 1 Potassium hydroxide preparation – Incorrect.…”

“…Answers: Punch biopsy for histologic diagnosis – Correct. The differential diagnosis for a patient with bilateral lower leg edema accompanied with hyperpigmented patches and plaques includes lymphedema, lipodermatosclerosis, Kaposi sarcoma (KS), stasis dermatitis, chronic venous insufficiency, and many other entities 1 . Our patient has poorly controlled HIV, and a biopsy is necessary to rule out KS.Initiation of intravenous vancomycin – Incorrect.…”

“…Although lipodermatosclerosis is a diagnostic consideration in our patient's clinical presentation, CD31 and human herpes virus 8 (HHV-8) positivity indicate KS. Interestingly, there are increasing reports of KS mimicking other clinical and histologic entities including lymphangioma-like KS, pyogenic granuloma–like KS, lipodermatosclerosis–like KS, and ecchymotic KS 1, 2, 3Lymphedema – Incorrect.…”