Cellulitis

Case contributed by Dr Nikola Todorovic

Presentation

Swollen elbow and forearm with increased local temperature and mild erythema.

Patient Data

Age: 35
Gender: Male
Photo

Swollen elbow and proximal part of the forearm with erythema. Full extension is almost impossible.

Ultrasound

Diffuse oedema, laminar free fluid, and several small fluid collections. There is thickening and echogenicity of the subcutaneous tissue. 

There are no signs of vein thrombosis.

X-ray

There are no pathological changes in the structure and morphology of the humerus, ulna, and radius to suggest osteomyelitis. Significant soft tissue swelling is due to subcutaneous oedema.

Case Discussion

Patient attended their GP with elbow and proximal forearm swelling, moderate pain, and restricted extension. He recalls having a small scratch on the elbow skin several days ago.

Lab results:

  • white cell count: 11.53
    • neutrophils: 8.57 (74.3%)
    • lymphocytes: 1.98 (17.2 %)
  • ESR: 10
  • CRP: 58.6.

The differential diagnosis includes cellulitis, osteomyelitis, septic arthritis, and olecranon bursitis. Examination, ultrasound, and x-ray findings are in keeping with uncomplicated cellulitis. Initial treatment is with antibiotics, elevation, and monitoring erythema for improvement.

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Case information

rID: 54779
Case created: 27th Jul 2017
Last edited: 28th Jul 2017
Inclusion in quiz mode: Included

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