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[Bacterial cellulitis. Forms borderline between medical and surgical (3 cases)]
M Pavlovic1, C Le Breton, F Granier
1Service de Dermatologie, Hôpital Ambroise Paré, Boulogne, France.
Annales De Dermatologie Et De Venereologie
|January 7, 2003
Summary
Severe leg cellulitis unresponsive to antibiotics can indicate a surgical emergency. Surgical decompression of compartment syndrome, even without necrosis, rapidly cured three patients with borderline infectious cellulitis.
Area of Science:
- Infectious Diseases
- Surgical Pathology
- Medical Imaging
Background:
- Acute infectious cellulitis management varies from medical to surgical interventions.
- Distinguishing between non-necrotizing and necrotizing forms is critical for treatment.
- Borderline cases present diagnostic and therapeutic challenges.
Observation:
- Three patients with acute leg cellulitis showed initial signs of moderate severity.
- Despite appropriate antibiotic therapy, clinical deterioration occurred, suggesting compartment syndrome.
- Magnetic resonance imaging (MRI) suggested non-necrotizing cellulitis in two patients, with necrotizing fasciitis suspected in one.
Findings:
- Surgical exploration revealed significant non-purulent fluid accumulation causing compartment syndrome, without abscess or necrosis.
- Surgical decompression via large incision led to rapid patient recovery.
- These cases represent a unique presentation of infectious cellulitis requiring surgical intervention.
Implications:
- Infectious cellulitis with compartment syndrome may necessitate surgical decompression, even without clear signs of necrosis.
- Early surgical intervention can be curative in complex cellulitis cases.
- MRI can aid in diagnosing challenging cellulitis presentations, guiding surgical decisions.