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Pelvic cellulitis: a life-threatening complication of hemorrhoidal banding.

Rubber band ligation is a commonly employed office procedure for the eradication of symptomatic internal hemorrhoids. Since 1980 increasingly frequent reports of an often fatal complication--"pelvic cellulitis"--have appeared. Death has been avoided for some of these patients by early recognition and treatment. One such survivor is reported here, in a case report that illustrates the value of early recognition of symptoms and appropriate diagnostic and therapeutic intervention.

Adult↗

Computerized tomography in the management of acute orbital cellulitis.

The usefulness of computerized tomography (CT scanning) in managing orbital cellulitis is analyzed in six cases. What appears as orbital abscess on CT scan may not be confirmed at surgery. Careful clinical evaluation and responsiveness to antibiotic therapy are most important in determining the need for surgical intervention.

Adolescent↗

[Facial cellulitis and Haemophilus meningitis in infants].

Two cases of facial cellulitis due to Haemophilus influenzae serotype b are reported in 2 infants aged 3 and 6 months. Bacteriological diagnosis relied on blood cultures. Association with bacterial meningitis emphasizes the necessity of a systematic cerebrospinal fluid examination and the choice of antibiotherapy.

Cellulitis↗

Neonatal zygomycotic necrotizing cellulitis.

Zygomycosis is a rare infection that should be suspected in any patient with a fulminant necrotizing cellulitis in an area recently covered with adhesive bandages or dressings. Early diagnosis and treatment are essential for patient survival.

Cellulitis↗

Paecilomyces lilacinus cellulitis in an immunocompromised patient.

Paecilomyces lilacinus, a saprophytic soil fungus, is an uncommon human pathogen. An immunocompromised patient developed a deep cellulitis due to P lilacinus. The infection responded poorly to intravenous amphotericin B but eventually resolved after combination therapy with amphotericin B and flucytosine (5-fluorocytosine). Previous in vitro studies have suggested that miconazole is the most active antifungal agent against P lilacinus.

Cellulitis↗

Vibrio cholerae non-01 cellulitis.

A 46-year-old man presented with pain and fever and a postphlebitic ulcer on his left leg. The wound was suppurative and open at the margins, but there was little underlying fasciitis and no apparent muscle or blood vessel involvement. Three separate wound cultures were obtained at two-day intervals, and all showed only Vibrio cholerae non-01. The patient was successfully treated with cefazolin sodium. This marks the second documented case of V cholerae non-01 type alone as a causative agent of cellulitis, and the first case where no saltwater origin could be demonstrated.

Cefazolin↗

Cellulitis associated with coagulase-positive staphylococci in racehorses: nine cases (1975-1984).

Nine Thoroughbred racehorses were admitted with cellulitis (of one or more limbs) associated with coagulase-positive staphylococci. The right hindlimb was affected in 4 horses, the right forelimb in 2, the left hindlimb in 1, and both hindlimbs in 2. Typical abnormalities included high values for rectal temperature (9 horses) and heart rate (5 horses), hyperfibrinogenemia (7 horses), leukocytosis (7 horses), and neutrophilia (6 horses). The staphylococcal isolants were speciated in 3 horses and classified as Staphylococcus aureus. Complications included skin loss (5 horses), laminitis of the affected limb (2 horses), laminitis of the contralateral limb (4 horses), osteomyelitis and sequestrum formation (2 horses), and bacteremia (1 horse). Five horses were euthanatized because of the severity of the complications, ie, laminitis in 4 horses and severe skin loss in 1 horse. The remaining 4 horses were discharged from the clinic. At follow-up evaluation (mean, 16.7 months), the swelling in 3 of the horses had completely resolved. One horse returned to racing; of 2 used for pleasure riding, one was mildly lame. The remaining horse was not lame, but was used for breeding because of persistent swelling of the affected limb.

Animals↗

Extensive squamous cell carcinoma of the conjunctiva presenting as orbital cellulitis: the hermit syndrome.

The authors present three cases of extensive squamous cell carcinoma of the conjunctiva invading the orbit and masquerading as orbital cellulitis. All cases were in elderly alcoholic men living in relative social isolation. Total exenteration of the orbit was required in all three cases. Only one patient has had long-term follow-up; he was well 5 years after presentation. The other two patients were well 15 and 5 months after surgery.

Aged↗

Frontal sinus abscess and secondary orbital cellulitis.

Despite modern antibiotics, frontal sinus abscess (and secondary orbital cellulitis) remains relatively common and potentially life-threatening. The declining incidence of chronic middle ear disease in the UK has made it one of the commonest causes of intracranial abscess. The speed with which suppuration can penetrate the sinus walls remains poorly understood and a research challenge. Management is best supervised by an ENT surgeon because the key decision is the timing of sinus surgery. The ENT surgeon, nevertheless, must be alert to the indications for consultation with neurosurgical colleagues. This paper aims to give an illustrated account of the clinico-pathological features and current management.

Abscess↗

Amikacin therapy for Pseudomonas cellulitis in an Amazon parrot.

Amikacin sulfate, an aminoglycoside antibiotic, was used successfully to treat a case of severe Pseudomonas cellulitus in an Amazon parrot. Side effects of polyuria and polydipsia occurred, but resolved without treatment 3 weeks after the antibiotic regimen. Amikacin sulfate was given at a dosage of 0.04 mg/g of body weight, IM, twice a day, based on antimicrobial sensitivity results. Amikacin sulfate is indicated for P aeruginosa cellulitis that is resistant to gentamicin sulfate. Although it is potentially nephrotoxic, it can be used successfully in birds without permanent clinically evident renal effects.

Amikacin↗

[Necrotizing cellulitis and fasciitis of infectious origin. Review of 10 personal cases and the literature].

Ten personal cases of necrotizing cellulitis and fasciitis are reported. The lower limbs were the most common site of infection. Two patients had involvement of the whole of the leg and died of septic shock. Two other patients died of pulmonary embolism. Bacteriological investigations showed multiple infection to be the rule; gangrene due to streptococcal infection alone was only observed in 3 cases, staphylococcus alone in 1 case and serratia alone in 1 case. Surgery was performed within 48 hours of admission under antibiotic cover in all but two cases. The authors emphasize the need for adequate anticoagulation to prevent multiple venous thrombosis in the infected subcutaneous tissues and to avoid the risk of fatal pulmonary embolism.

Aged↗

Lethal toothache: parapharyngeal cellulitis complicating dental infection.

Three patients with parapharyngeal cellulitis arising from dental infection were seen by the Medical Service over a period of ten months. Respiratory distress and/or pharyngeal discomfort prompted all patients to seek medical aid. The extent of infection within the parapharyngeal space, the potential for life-threatening complications, and the significance of the dental lesions were not appreciated initially in all cases. Despite early antibiotic therapy, one patient died and one incurred severe neurologic sequelae. Early recognition, use of antibiotics effective against anaerobic bacteria, and prompt surgical drainage are mandatory to prevent considerable morbidity and mortality. Control of the airway is the most important therapeutic maneuver leading to a favorable outcome.

Adult↗

Fatal perineal cellulitis from an episiotomy site.

Perineal cellulitis originating from an episiotomy incision resulted in 20% of the maternal mortality in King County, Washington, between 1969 and 1977. Necrotizing fasciitis was present in 2 of the cases, and clostridial myonecrosis was present in 1. These fatalities occurred because the practitioners were not aware that necrotizing fasciitis can occur in the fatty superficial fascia of the perineum and that resection of the necrotic tissue is necessary for successful therapy.

Adult↗

Cellulitis caused by Vibrio alginolyticus.

A case of cellulitis, resulting in a recurrence of a leg ulcer is presented due to the unique association of its bacterial flora, consisting exclusively of V. alginolyticus and of its clinically rapid expansion after seabathing.

Adult↗

[Gangrenous cellulitis of the face. Apropos of a case].

Gangrenous cellulitis of the face of dental origin had a very abrupt onset, spread rapidly in spite of treatment and led to severe pleuropericardial complications. The outcome was favorable after repeated thoracic surgery. Preventive therapeutic measures for these major accidents are discussed, following a detailed report on the case presented and treatment modalities applicable, fatal outcomes still being possible in 1984 in spite of progress in therapy.

Cellulitis↗