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PubMed2005

Abdominal wall cellulitis in the morbidly obese.

Currently, almost two-thirds of the US population is either overweight or obese. In addition to non-infectious complications, obesity predisposes to infections, including lower extremity cellulitis. Although cases of abdominal wall cellulitis in the morbidly obese occur, to date there has been no formal address of this syndrome in the literature. We therefore reviewed our clinical experience of abdominal wall cellulitis complicating morbid obesity. A retrospective database search was performed to identify patients with both cellulitis and morbid obesity who were seen at the Mayo Clinic between January 1998 and August 2003. Clinical and microbiologic data were collected for these patients. Of the 260 cases of cellulitis identified, 24 (9.2%) had morbid obesity and abdominal wall cellulitis. The mean age of the 24 patients was 47 (range 22-70) y and over two-thirds of them were females. Their mean body mass index (BMI) was 62.3 (range 39.6-108.6). 17 (70.8%) had a remote history of abdominal surgery. 16 patients required 23 hospitalizations. Five patients developed cellulitis complications and 7 (29.1%) patients had recurrent bouts of cellulitis during the study period. Abdominal wall cellulitis is a unique infectious complication in patients with morbid obesity. Further study is needed to better define the pathogenesis of this illness to develop strategies in treatment and prevention.

Abdominal Wall↗
PubMedDate not supplied

Trends in cellulitis condemnations in the Ontario chicken industry between April 1998 and April 2001.

We conducted a retrospective study to determine the prevalence of cellulitis condemnations in the Ontario chicken industry and the relative proportion of variation attributable to factors that vary between processors, producers, and lots and over time. The time span studied was April 1998 to April 2001. We obtained condemnation data randomly from the Chicken Farmers of Ontario and analyzed the data with a generalized mixed model. The (weighted) average prevalence of cellulitis in Ontario between April 1998 and 2001 was 0.94% (0.87%, 1.03%). The prevalence of cellulitis ranged from 0% to 14.9%, with one outlier at 30% and 95% of the data between 0 and 2.58%. The final mixed model we used to describe the variation in the prevalence of cellulitis between lots included random effect terms, the plant where the birds were processed, the producer, the quota period when the birds were processed, and the interaction term quota period by processing plant, as well as fixed effects terms, the type of inspection system and the average weight of the birds. The final model containing these variables explained approximately 78% of the total variation in the data. Our findings indicate all three random effects variables accounted for a significant amount of variation in the cellulitis data; however, the greatest source of variation was ascribed to the plants where the birds were processed. Some of the variation in cellulitis associated with processing plants was explained by the type of inspection system used by the plant, but even after controlling for this factor, there remained a relatively large amount of variation between processing plants (approximately 30%). These findings suggest there may be discrepancies in the diagnoses of the condition. Some of the variation in the prevalence of cellulitis (approximately 13%) was also attributed to the producer; however, more of the variation in the data was attributed to differences in lot-specific factors (approximately 22%). Therefore, future control efforts for cellulitis should focus on standardizing the classification of cellulitis at processing plants and identifying lot specific factors that may increase the risk of the condition.

Animals↗
PubMed2004

A prospective study of management and litter variables associated with cellulitis in California broiler flocks.

Cellulitis has emerged as an economically important disease of broiler chickens. The impact of environmental risk factors on the incidence of cellulitis has not been evaluated in the United States. Escherichia coli (E. coli), the causative agent, is introduced through skin scratches during the grow out. Our previous work suggested that the litter was an important reservoir for cellulitis-associated E. coli. We hypothesized that factors contributing to a positive environment for E. coli growth would increase the opportunity for exposure of a broiler to an infectious dose of E. coli, capable of initiating a cellulitis lesion. This prospective study of 304 flocks on five farms from two integrated broiler companies was conducted to determine the effect of environmental factors on the prevalence of cellulitis in California broiler flocks. Environmental variables included temperature, wind velocity, and relative humidity (RH) at the litter surface. Litter variables measured included E. coli and total gram-negative bacteria load (colony forming units/g dry matter), water activity, and pH. Management variables such as clean out, the number of flocks reared on the same litter (litter run, LR), and downtime (DT) between flocks were also evaluated. Cellulitis ranged from 0.197% to 6.04%. Significant associations were identified using linear regression between farm, LR, DT, ambient temperature during the brooding period, gram-negative bacteria load in the litter during the brooding period, RH mid-grow out, and E. coli load late in the grow out. The significant variation in the rate of cellulitis between farms combined with the strong association of LR and DT with cellulitis demonstrated that management choices were highly influential in this disease syndrome. Based on these data and our previous findings, managers would be advised to increase DT between flocks and perform a total clean out of the house when a flock processes with a high incidence of cellulitis.

Animal Husbandry↗
PubMed1994

[Orbital cellulitis in children].

BACKGROUND: Because the potential for complications is great, orbital cellulitis must be recognized promptly and treated aggressively. POPULATION AND METHODS: The files of 38 children admitted from 1988 to 1993 because of orbital or periorbital cellulitis were retrospectively analyzed. Clinical findings included fever, edema, pain, rhinorrhea, conjunctivitis, limitation of eye movement, loss of vision and ophthalmoplegia. All patients had hemogram, ionogram, blood cultures, search for soluble antigens in blood and/or urine, C-reactive protein measurement; they also had roentgenographic examination of the sinuses, orbital ultrasonography and/or CT scan in patients with retroseptal cellulitis. All patients were given systemic antibiotic therapy. RESULTS: Thirty-five patients had preseptal and three retroseptal cellulitis. Preseptal cellulitis was associated to sinusitis in 17 patients, to ocular infection in 11 (seven conjunctivitis and four dacryocystitis), to an infected wound in six. Seventy-three per cent of the patients with ocular infection were less than 2 years of age with a significant preponderance of girls (64%). The three cases of retroseptal cellulitis were associated to sinusitis. Orbital echography was performed in five cases, permitting to recognize the three cases of retroseptal cellulitis that was confirmed by CT scan. Twenty-five of the 38 children were given oral antibiotics during the days preceding admission, explaining the relative rarity of positive bacteriological findings (seven cases). Thirty-five of the 38 children were given IV cefotaxime + fosfomycin, associated to netromycin in 16 cases. Mean duration of treatment was 3 days (range: 1-7). IV antibiotherapy was followed by oral amoxicillin-clavulanic acid administration in 25 patients and pristinamycin in 11. CONCLUSIONS: Orbital cellulitis in children, more frequently preseptal, have a good prognosis under adapted antibiotherapy. A retroseptal cellulitis requires multidisciplinary management because of the risk of extension of infection from the orbit to the eye and/or into the cranial cavity.

Anti-Bacterial Agents↗
PubMedDate not supplied

Periorbital cellulitis.

Periorbital cellulitis is a commonly occurring infectious process limited to the eyelids in the preseptal region. It occurs with greater frequency in the pediatric age group. It is important to distinguish this disease from orbital cellulitis, a potentially lethal infectious process involving the contents of the orbit. A retrospective study of clinical and laboratory data from 137 cases with orbital and periorbital cellulitis was performed. Periorbital cellulitis was documented in 98 cases (71%) in contrast to orbital cellulitis, which was noted in 39 (28%) patients. Sinusitis was the most frequently encountered predisposing factor for the development of periorbital cellulitis occurring in 29 patients. All patients with a diagnosis of periorbital cellulitis were hospitalized and received antibiotics, the majority (95%) receiving intravenous therapy. Hemophilus influenzae was the most frequently isolated pathogenic organism. It was necessary to operate on eight patients. Six patients underwent incision and drainage of an eyelid or periorbital abscess. A distinction between periorbital and orbital cellulitis is clarified. The separation of these entities on the basis of physical examination and radiographic studies is stressed.

Adolescent↗
PubMed1983

Bacterial periorbital and orbital cellulitis in childhood.

The clinical features, microbiologic data, complications, and treatment in 137 children with periorbital cellulitis and 21 children with orbital cellulitis is presented. Periorbital cellulitis was more frequent (87%) than orbital cellulitis (13%). Periorbital cellulitis is a heterogeneous disease that may complicate trauma of the eyelids, external ocular infection, and upper respiratory infection. Children with periorbital cellulitis related to trauma or external infection tended to be less than 5 years old with negative blood cultures (99%) and positive cultures of percutaneous aspirates (42%); while children with periorbital cellulitis related to upper respiratory infection also tended to be less than 5 years of age, but blood cultures were frequently positive (42%) and cultures of percutaneous aspirates were usually negative (92%). Three children in the latter group developed meningitis. Intravenous antibiotic alone was effective treatment in most patients (90%). Orbital cellulitis was more frequent in children older than 5 years and frequently associated with sinusitis (90%). Blood and skin cultures were usually negative. Intravenous antibiotics alone were effective management in many patients (62%), but a significant proportion required paranasal sinus or orbital surgery (38%).

Bacterial Infections↗
PubMedDate not supplied

Evaluation of the adhesive capacity of Escherichia coli isolates associated with avian cellulitis.

It has been shown that Escherichia coli isolates from lesions of cellulitis belong to a limited number of clonal groups distinct from those of isolates found in the environment of these birds. In this study, different in vitro methods were used to evaluate adherence properties of E. coli isolates from cellulitis lesions and environments of high- and low-cellulitis prevalence broiler flocks. One hundred isolates were tested by hemagglutination. Adherence to frozen sections of chicken skin and binding to soluble fibronectin were examined for 40 of these 100 isolates by immunofluorescence and by immunocytofluorometry, respectively. Localization of bacterial adherence to skin tissues was confirmed by immunohistochemistry. It was demonstrated that O78:K80 isolates from cellulitis lesions adhered to skin sections to a much greater extent in deeper than in superficial tissue layers. A greater bacterial adherence following growth in TSB at 37 C was demonstrated for isolates from flocks with high prevalence of cellulitis than for isolates from flocks with low prevalence of cellulitis. MANOVA analysis results showed a significant difference between superficial and deep tissue layers only for one set of isolates from flocks with high prevalence of cellulitis. Hemagglutinating activity was variable among the O78:K80 isolates obtained from flocks with high prevalence of cellulitis. The results obtained for some O78:K80 isolates following growth in TSB suggest a role for type 1 fimbriae or F1 in adherence to skin sections. This was reinforced by the finding that adherence was inhibited by D-mannose. Poultry E. coli isolates that express F1 had no affinity for soluble fibronectin, although localization of the adherence in skin sections suggested a role for extracellular matrix components such as collagen and insoluble fibronectin.

Animals↗
PubMed2001

[Subacute forms of necrotizing fasciitis and necrotizing cellulitis: diagnosis criteria and surgical decision-making].

Subacute cellulitis could be described as intermediary forms between benign erysipelas and life-threatening necrotizing fasciitis with toxic shock syndrome. The key point is to consider any cellulitis a possible indication for surgery. Subacute cellulitis may occur in the elderly or diabetic patients. Local signs (cyanosis, necrosis.) are sometimes isolated. They may occur during the evolution of cellulitis requiring a medical treatment. This emphasizes the importance of carefully following-up any patient treated by antibiotics for cellulitis, i.e. monitoring the extension of erythema (using a felt-pen) and atypical local signs. Complementary investigations are especially helpful when diagnosing cellulitis requiring a surgical treatment: fine-needle aspirations; histology; soft-tissue X-ray; MR imaging that can detect alterations of the cutis and fascia, myositis, and abscesses. Surgery can be delayed for such patients, allowing for a better preparation. Sometimes, only surgical exploration may confirm cellulitis. Lastly, some cases may mimic surgical cellulitis but a prolonged course of antibiotics is able to control the disease. Abscesses requiring secondary surgical evacuation may complicate all these insidious features.

Cellulitis↗
PubMedDate not supplied

Cellulitis in broiler chickens: a one-year retrospective study in four Québec abattoirs.

A 1-yr retrospective study was undertaken to verify whether the prevalence of cellulitis in broiler chicken flocks was associated 1) with sex and average body weight controlling for the time of year and 2) with some other condemnation causes such as air-sacculitis, ascites, cyanosis, emaciation, valgus varus deformity, peritonitis, and total condemnation rate controlling for sex, average body weight, and time of year. Data were collected from four Québec abattoirs between October 1992 and September 1993. Data from 2452 unisex male and female broiler flocks were compiled and analyzed with univariate and multivariate models. The prevalence of cellulitis among flocks was 42.2 per 10,000 birds slaughtered. Cellulitis was associated with sex and increased with time of year (P < 0.0001). The prevalence was higher in male (mean +/- SD, 50.7+/-24.3; median, 31.8) than in female flocks (mean +/- SD, 34.2+/-15.6; median, 20.0) but showed no relationship with average body weight. Associations between condemnation causes and cellulitis were relatively weak; increases in the prevalence of cellulitis correlated with increases in total condemnation rate (r2 = 0.19), ascites (r2 = 0.09), airsacculitis (r2 = 0.0), cyanosis (r2 = 0.04), peritonitis (r2 = 0.03), emaciation (r2 = 0.02), and valgus varus deformity (r2 = 0.02). These results suggest that flock sex is a potential correlate of cellulitis prevalence in broiler chickens. Associations between the prevalence of cellulitis and other diseases observed at the abattoir were not very strong. However, it appears here that general disease status of Québec broiler flocks is a better indicator of cellulitis occurrence than the main diseases considered individually.

Animals↗
PubMedDate not supplied

Escherichia coli cellulitis: experimental infections in broiler chickens.

The objectives of this study were to evaluate the role of trauma to the skin in development of Escherichia coli cellulitis and to compare the abilities of three cellulitis isolates (O78, O115, O21,83), one airsacculitis isolate (untypable) and one fecal isolate (O86) of E. coli to induce cellulitis in broiler chickens. Forty-eight 4-week-old commercial broiler chickens were housed in groups of six in eight battery cages. For five groups, the skin on the left side of the abdominal region of chickens was traumatized by scratching with a 22-gauge needle, then contaminated with a swab dipped in a broth culture of one of the five E. coli isolates. For chickens in the remaining three groups, an avian cellulitis culture (O115, O21,83) or sterile broth was applied to intact skin. The experiment was duplicated. All birds were euthanatized 10-13 days postinoculation. No lesion developed in chickens in which the skin had not been traumatized. Among the traumatized birds, cellulitis isolates induced characteristic lesions of cellulitis in 86% of the birds, whereas airsacculitis and fecal isolates induced lesions in 42% and 8% of birds, respectively. Severe or moderate gross pathologic changes were found in 86% and microscopic pathologic changes were found in 88% of birds inoculated with cellulitis isolates; the corresponding percentages for the airsacculitis isolate were 25% and 17%. This study demonstrated that trauma to the skin is necessary for initiating disease and that strains of E. coli of serotypes epidemiologically associated with cellulitis are highly virulent in experimental infection.

Animals↗
PubMed2001

[A prospective study on erysipelas and infectious cellulitis: how are they dealt within hospital?].

771 cases of erysipelas and 52 cases of infectious cellulitis were collected over 3 months in a prospective study carried out in French hospitals. The mean age was 62.7 +/- 19.3 years for the erysipelas patients and 69.7 +/- 16 years for the cellulitis patients. Sex-ratios were respectively 0.92 and 2.7. The infection was mainly localized in the lower limbs in both categories (90.9 p. 100 and 71 p. 100); the upper limbs and the face were more often involved in cellulitis than in erysipelas (13 p. 100 versus 5.2 p. 100 and 10 p. 100 versus 2.5 p. 100). Penicillin G was the initial antimicrobial treatment in 45 p. 100 of the erysipelas cases, whereas amoxicillin-clavulanic acid was used in 32.7 p. 100 of the cellulitis cases. Other antibiotics used were pristinamycin, antistaphylococcal penicillin, and amoxicillin. Combinations of antibiotics were used to treat 50 p. 100 of the cellulitis cases but only 11 p. 100 of the erysipelas cases. Anticoagulants were used in 67.4 p. 100 of the erysipelas cases and in 59.7 p. 100 of the cellulitis cases. Surgery was performed in 52 p. 100 of the cellulitis cases, and hyperbaric oxygen in 4.2 p. 100. The outcome was quite different for the 2 diseases: cure rate without complications reached 86.6 p. 100 for erysipelas, and only 48.1 p. 100 for cellulitis; death rates reached respectively 0.77 p. 100 and 5.7 p. 100, median length of hospitalization 8 days and 21 days, and median length of antibiotic treatment 15 days and 21 days.

Erysipelas↗
PubMedDate not supplied

Comparison of short-course (5 days) and standard (10 days) treatment for uncomplicated cellulitis.

BACKGROUND: Cellulitis is a condition routinely encountered in the primary care setting. No previous study has compared a short (5 days) vs standard (10 days) course of therapy of the same antibiotic in patients with uncomplicated cellulitis. METHODS: We performed a randomized, double-blind, placebo-controlled trial to determine if 5 days of therapy has equal efficacy to 10 days of therapy for patients with cellulitis. Of 121 enrolled subjects evaluated after 5 days of therapy for cellulitis, 43 were randomized to receive 5 more days of levofloxacin therapy (10 days total antibiotic treatment), and 44 subjects to receive 5 more days of placebo therapy (5 days of total antibiotic treatment). Levofloxacin was given at a dose of 500 mg/d. Subjects were not randomized if they had worsening cellulitis, a persistent nidus of infection, a lack of any clinical improvement, or abscess formation within the first 5 days of therapy. The main outcome measure was resolution of cellulitis at 14 days, with absence of relapse by 28 days, after study enrollment. RESULTS: Eighty-seven subjects were randomized and analyzed by intention to treat. There was no significant difference in clinical outcome between the 2 courses of therapy (success in 42 [98%] of 43 subjects receiving 10 days of antibiotic, and 43 [98%] of 44 subjects receiving 5 days of antibiotic) at both 14 and 28 days of therapy. CONCLUSION: In patients with uncomplicated cellulitis, 5 days of therapy with levofloxacin appears to be as effective as 10 days of therapy.

Analysis of Variance↗
PubMed2005

Orbital cellulitis: a rare complication after orbital blowout fracture.

PURPOSE: To report the incidence of orbital cellulitis after orbital blowout fracture. DESIGN: Retrospective, noncomparative, interventional case series. PARTICIPANTS: All patients with orbital cellulitis and a history of recent orbital fracture. METHODS: A medical record review of clinical history, imaging studies, and surgical and treatment outcome was performed. MAIN OUTCOME MEASURES: Resolution of orbital cellulitis and surgical and imaging findings. RESULTS: Four patients (3 male; mean age, 30 years [range, 4.5-58]) were treated for orbital cellulitis complicating orbital fracture. All patients had evidence of paranasal sinusitis before or after the orbital injury, and 2 also reported forceful nose blowing after sustaining orbital trauma. Although 3 patients received prophylactic oral antibiotics after the fracture, this failed to prevent infection. Sinusitis commenced 1 to 2 weeks before and as late as 5 weeks after orbital injury. All patients were treated with IV antibiotics. Two developed an orbital abscess that required surgical drainage; 1 patient improved after an endonasal maxillary antrostomy. One patient improved on IV antibiotics alone and underwent fracture repair at a later stage. These 4 patients represent 0.8% of all cases of orbital fractures treated in the study period. CONCLUSIONS: Orbital cellulitis is a rare complication of orbital fracture, and seems to be more common when paranasal sinus infection preexists or occurs within several weeks of the injury. Oral antibiotics given after the orbital injury may not prevent orbital cellulitis or abscess formation. Surgery may be required to drain orbital abscess or in nonresolving cellulitis to drain the paranasal sinuses. Fracture repair, if indicated, should be delayed, particularly if an alloplastic implant is used.

Acute Disease↗
PubMed2000

Persistence of cellulitis-associated Escherichia coli DNA fingerprints in successive broiler chicken flocks.

Avian cellulitis in broiler chickens is primarily caused by Escherichia coli. Previous research found that the E. coli isolates of cellulitis origin were unique to each ranch, suggesting that these E. coli were endemic within the ranch environment. To test the hypothesis that the E. coli associated with cellulitis are endemic in the litter of the broiler house, we designed a study to determine whether E. coli DNA fingerprints associated with cellulitis persist over successive flocks that are grown in the same house. In addition, we assessed the impact of different cleaning and disinfection strategies on this persistence. Two broiler houses were followed on each of five farms over 3-4 flocks. A total of 353 E. coli isolates from cellulitis lesions were analyzed in this study, and 314 of these isolates (89%) were DNA fingerprinted by PFGE. In each ranch, there were several DNA fingerprint patterns that were present over successive flocks, regardless of the cleaning and disinfection strategy utilized. Isolates persisted as long as 191 days, implying that these E. coli are capable of persisting in the broiler house environment for long periods of time. In addition, these E. coli isolates were associated with cellulitis lesions in successive flocks. Thus, the isolates of E. coli that are associated with cellulitis in broiler chickens appear to be endemic in the litter environment of the broiler house.

Animal Husbandry↗
PubMed2006

Preseptal and orbital cellulitis: a 10-year review of hospitalized patients.

BACKGROUND: Preseptal and orbital cellulitis range in severity from minor to potentially severe complications. The purpose of this study is to describe the clinical features of patients with preseptal or orbital cellulitis in one medical center in Taiwan, and to assess the effectiveness of treatments and the complications. METHODS: Patients admitted between 1996 and 2005 to Taipei Veterans General Hospital under the diagnosis of preseptal or orbital cellulitis were retrospectively reviewed. The demographics, administrative history, past history, clinical presentations, treatments, and complications were analyzed. RESULTS: In total, 94 patients fulfilling the diagnostic criteria for preseptal or orbital cellulitis were identified (67 had preseptal cellulitis, 27 had orbital cellulitis). While paranasal sinus disease was the most common predisposing cause in orbital cases, skin lesions in children and dacryocystitis in adults were the most common in preseptal cases. Microbiologic investigations showed variable results, but the most common pathogen isolated was Staphylococcus aureus. Cultures from eye swabs and local abscesses gave the highest positive yield. Blood cultures were taken in some patients, but the positive rate was extremely low. Treatments included intravenous antibiotics alone, or intravenous antibiotics combined with surgical drainage. Only one case had permanent ocular motility impairment after removal of the orbital foreign body. CONCLUSION: Despite the past history of potential morbidity and even mortality from orbital cellulitis, early diagnosis and prompt treatment with proper antibiotics and/or surgical intervention can achieve a good prognosis.

Adolescent↗
PubMed2006

Cellulitis incidence in a defined population.

A population-based insurance claims database was used to examine cellulitis incidence, anatomical sites of infection, complicating diagnoses, source of health service, and recurrence rates. Insurance claim files were searched for cellulitis ICD-9-CM codes 681.0-682.9. Complications of cellulitis including erysipelas, lymphadenitis, lymphangitis, and necrotizing fasciitis were also identified by ICD-9-CM codes. We found a cellulitis incidence rate of 24.6/1000 person-years, with a higher incidence among males and individuals aged 45-64 years. The most common site of infection was the lower extremity (39.9%). The majority of patients were seen in an outpatient setting (73.8%), and most (82.0%) had only one episode of cellulitis during the 5-year period studied. There was a very low incidence of cellulitis complications, including necrotizing fasciitis. Cellulitis is fairly common, usually treated in outpatient settings, and is infrequently complicated by erysipelas, lymphadenitis, lymphangitis, or necrotizing fasciitis.

Adolescent↗
PubMed1998

Breast cellulitis following breast conservation therapy: a novel complication of medical progress.

Breast cellulitis is a novel complication of the recently accepted practice of breast conservation therapy. This phenomenon represents an anatomic shift from ipsilateral upper extremity cellulitis seen in past years when mastectomy with axillary lymph node dissection was performed for treatment of limited disease due to breast cancer. Thirteen episodes of breast cellulitis in nine women who underwent breast conservation therapy for stage I or II breast cancer are presented. The mean duration from the end of radiotherapy to the initial episode of cellulitis was 4.9 months. Eighty-three percent of episodes occurred in patients who had radiologically demonstrated fluid collections at the surgical lumpectomy site prior to the onset of cellulitis. Eight (61.5%) of 13 episodes occurred within 3 months of a follow-up mammogram of the treated breast. Two patients developed recurrent cellulitis within a 6-month period. Breast cellulitis may be more commonly seen in clinical practice as an increasing number of patients undergo breast-sparing procedures for treatment of limited disease due to cancer.

Adult↗
PubMed1997

Cellulitis of the breast as a complication of breast-conserving surgery and irradiation.

Breast-conserving therapy (BCT) has become a standard treatment option for patients with early-stage breast cancer. We have observed cellulitis of the treated breast as a complication occurring before, during, and after breast irradiation. The cases of five women (median follow-up, 28 months; range, 24-65 months) who developed cellulitis before (n = 1), during (n = 2), or after (n = 2) breast irradiation were reviewed. A consecutive series of BCT patients at Emory University was reviewed to determine the incidence of this complication. Four of five women had an axillary dissection, yielding a median of 14 negative lymph nodes (range, 6-22 nodes). Two of four patients developed axillary seromas requiring aspiration. In these four patients, only the breast was irradiated. A fifth patient had no axillary dissection and had breast and supraclavicular/axillary irradiation. The median whole breast dose was 50 Gy (range, 46-50.4 Gy). The clinical features of cellulitis included erythema, edema, tenderness, and warmth in all patients. Cellulitis was a relapsing problem for four of the five patients. The incidence of this complication in our series of BCT patients was approximately 1%. Cellulitis in the ipsilateral breast can be a relapsing complication of BCT and can be seen before, during, or after breast irradiation. Axillary seromas and aspiration seem to indicate a subset of patients at risk of early cellulitis. Late cellulitis may be caused by a variety of factors related to modifications of vascular and skin integrity by surgery and radiotherapy. Prompt diagnosis and appropriate antibiotic therapy is recommended. This problem need not interrupt a course of breast irradiation, and does not necessarily lead to a poor cosmetic result.

Adult↗