Streptococcal cellulitis proved by skin biopsy in a coronary artery bypass graft patient

There has been a question about the etiology and pathogenesis of recurrent cellulitis of the lower leg in patients following coronary artery bypass graft surgery. We observed a similar patient who had gram-positive cocci in chains, consistent with streptococci, within the dermis in a tissue biopsy specimen taken from the site of cellulitis. In addition, our patient had a second skin infection, namely, tinea pedis, which may be the portal of entry for streptococci. Concurrent treatment with a systemic antibiotic and a topical antifungal cream was effective in clearing both infections.