Orbital cellulitis associated with Toxocara canis in a dog

Reports of Toxocara canis ocular larva migrans are uncommon in animals, with only a few cases reported. Most reports involve larval migration into the retina and choroid, with parasitic invasion of the orbit reported only in experimental studies. This is the first clinical case of Toxocara canis infection in the retrobulbar region of a 10-year-old, cross-bred male dog presenting with unilateral orbital cellulitis. Ophthalmic signs included protrusion of the nictitating membrane, chemosis, exophthalmos and hypertropia. The parasite was diagnosed by histologic and parasitologic examination of orbital tissues, which were removed during enucleation.

Histoplasmosis presenting as cellulitis 18 years after renal transplantation

A 49-year-old renal transplant patient, under an 18-year course of immunosuppressive therapy with prednisone and azathioprine and, more recently, prednisone plus mycophenolate sodium, developed a cutaneous-subcutaneous infection caused by Histoplasma capsulatum. The clinical presentation consisted of a slowly enlarging, erythematous and infiltrative 25 cm plaque in the major axis on the arm. There was no involvement of the lungs or any other organ. Cure was obtained with itraconazole treatment after 12 months. Histoplasmosis is an uncommon opportunistic infection among solid organ transplanted patients with incidence of 0% to 2.1% observed in a large number of cases. This report describes an atypical cutaneous clinical presentation of a potentially fatal disease in immunosuppressed patients.

Odontogenic infection causing orbital cellulitis in a pediatric patient

Odontogenic abscess can become an orbital cellulitis, causing potentially serious intracranial and orbital complications. The full clinical complications from odontogenic orbital cellulitis in a pediatric patient are rarely seen daily in hospital emergency departments. Thus, odontogenic orbital cellulitis still remains a rarity, resulting in a medical challenge. With this in mind, this study aimed to describe a case of periorbital and orbital cellulitis resulting from odontogenic origin in a 6-year-old patient who was successfully treated by performing intravenous antibiotic administration combined with surgical drainage. Copyright © 2013 by Mutaz B. Habal, MD.

Cutaneous reactive angiomatosis with combined histological pattern mimicking a cellulitis

Cutaneous reactive angiomatoses (CRA) encompass a distinct group of rare benign reactive vascular proliferations that include reactive angioendotheliomatosis, diffuse dermal angiomatosis and reactive intralymphatic histiocytosis. The etiology of these conditions, often associated with either localized or systemic diseases, is poorly understood. We report a 72-year-old woman who presented giant diffuse cellulitis-like plaques on the right lower limb and the pelvis and a reduction of her general condition with fever. Light microscopy studies revealed combined features of reactive angioendotheliomatosis, diffuse dermal angiomatosis and reactive intralymphatic histiocytosis. A small arteriovenous fistula of the right lower leg was thought to act as trigger. Systemic corticosteroids resulted in the clinical remission of the skin lesions. Our observation provides strong evidence that reactive angioendotheliomatosis, diffuse dermal angiomatosis and reactive intralymphatic histiocytosis, previously regarded as distinct forms of CRA, may show overlapping histopathological features and most likely represent facets of the same disease.

Giant cellulitis-like Sweet Syndrome, a new variant of neutrophilic dermatosis

BACKGROUND Neutrophilic dermatoses comprise a wide spectrum of inflammatory diseases with overlapping features characterized histologically by the presence of an aseptic neutrophilic infiltrate in the epidermis, dermis, and/or hypodermis and are often associated with systemic inflammatory and neoplastic disorders. OBSERVATIONS We describe 3 patients with an unusual neutrophilic dermatosis characterized by relapsing episodes of fever, widespread infiltrated plaques with bullous appearance, and variable involvement of the arms, legs, abdomen, and/or trunk. Light microscopy studies showed marked edema of the papillary dermis with an inflammatory infiltrate consisting mainly of mature neutrophils. All 3 patients were morbidly obese, and workup revealed underlying cancer in 2 cases: myeloma and breast carcinoma. Management of the underlying disease resulted in long-term remission of the skin disease. CONCLUSIONS The clinicopathologic features in our 3 cases best correspond to a widespread giant cellulitis-like form of Sweet syndrome. Knowledge of this newly observed unusual variant of Sweet syndrome within the broad spectrum of neutrophilic diseases is important for its prompt and proper management.

Prophylactic antibiotics for the prevention of cellulitis

Background: Cellulitis of the lower leg accounts for 2-3% of hospital admissions (Cox et al, 1998), with an average length of in-patient stay of nine days. Studies have reported that up to half of these patients suffer further episodes (Cox et al, 1998; Dupuy et al, 1999). Reducing the recurrence of cellulitis could therefore have a significant impact on both patient morbidity and NHS costs. Aims: To assess whether prophylactic antibiotics prescribed after an episode of cellulitis of the leg results in fewer subsequent attacks and reduced health service costs (PATCH prophylactic antibiotics for the treatment of cellulitis at home). Methods: This article describes two related studies in which participants are randomised to receive either 12 months of prophylaxis (PATCH I) or six months of prophylaxis (PATCH II). The PATCH I study recruits only patients with recurrent disease defined as two or more episodes of cellulitis in the last three years. PATCH II has more open criteria and includes patients with a first episode of cellulitis and also participants with recurrent disease. It is expected that 260 patients will be recruited into PATCH I and 400 patients into PATCH II.

Feasibility study to inform the design of a UK multi-centre randomised controlled trial of prophylactic antibiotics for the prevention of recurrent cellulitis of the leg

Background: This paper describes the results of a feasibility study for a randomised controlled trial (RCT). Methods: Twenty-nine members of the UK Dermatology Clinical Trials Network (UK DCTN) expressed an interest in recruiting for this study. Of these, 17 obtained full ethics and Research & Development (R&D) approval, and 15 successfully recruited patients into the study. A total of 70 participants with a diagnosis of cellulitis of the leg were enrolled over a 5-month period. These participants were largely recruited from medical admissions wards, although some were identified from dermatology, orthopaedic, geriatric and general surgery wards. Data were collected on patient demographics, clinical features and willingness to take part in a future RCT. Results: Despite being a relatively common condition, cellulitis patients were difficult to locate through our network of UK DCTN clinicians. This was largely because patients were rarely seen by dermatologists, and admissions were not co-ordinated centrally. In addition, the impact of the proposed exclusion criteria was high; only 26 (37%) of those enrolled in the study fulfilled all of the inclusion criteria for the subsequent RCT, and were willing to be randomised to treatment. Of the 70 participants identified during the study as having cellulitis of the leg (as confirmed by a dermatologist), only 59 (84%) had all 3 of the defining features of: i) erythema, ii) oedema, and iii) warmth with acute pain/tenderness upon examination. Twenty-two (32%) patients experienced a previous episode of cellulitis within the last 3 years. The median time to recurrence (estimated as the time since the most recent previous attack) was 205 days (95% CI 102 to 308). Service users were generally supportive of the trial, although several expressed concerns about taking antibiotics for lengthy periods, and felt that multiple morbidity/old age would limit entry into a 3-year study. Conclusion: This pilot study has been crucial in highlighting some key issues for the conduct of a future RCT. As a result of these findings, changes have been made to i) the planned recruitment strategy, ii) the proposed inclusion criteria and ii) the definition of cellulitis for use in the future trial.

Ossifying fibroma: A rare cause of orbital inflammation

Purpose: To describe the clinical and radiologic features of 4 cases of ossifying fibroma affecting the orbit and to review the literature on orbital involvement by the tumor. Methods: Small case series. Results: Four patients (3 children and 1 adult) with ossifying fibromas invading the orbit were examined. Two of the 3 children were examined for ossifying fibromas on the orbital roof. One had the psammomatoid form of the disease and the other the trabecular variant. Despite striking differences in the histologic pattern and in the radiologic appearance of the lesions, both children displayed a significant degree of orbital inflammation mimicking orbital cellulitis. The third child and the adult patient had the orbit involved by trabecular ossifying fibromas invading the orbital floor. The tumor of the adult clearly originated in the maxilla, filled the maxillary sinus, and eroded the orbital floor. The tumor of the third child occupied the maxillary, ethmoid, and sphenoid sinuses. In both cases, the clinical presentation was painless eye dystopia and proptosis. Conclusions: Regardless of the histologic pattern (trabecular or psammomatoid), ossifying fibromas can induce a substantial degree of orbital inflammation in children and must be included in the differential diagnosis of acute orbital inflammation during childhood.

Septic shock caused by Plesiomonas shigelloides in a patient with sickle beta-zero thalassemia

Invasive infection and extraintestinal complications are rarely caused by Plesiomonas shigelloides, a water-borne bacterium belonging to the Vibrionaceae family. We report a case of a 16-year-old female patient with sickle beta-zero thalassemia who survived septic shock caused by P. shigelloides associated with secondary acute respiratory distress syndrome and disseminated intravascular coagulation. Treatment with a carbapenem was successful, and the patient recovered without any sequelae. The previous reports of P. shigelloides sepsis are cited, and possible pathogenic mechanisms are discussed. (Heart Lung (R) 2010;39:335-339.)

Caracterização do fibro edema gelóide e respectivos tratamentos nos estudantes de fisioterapia

Mestrado em Fisioterapia

Acute primary cutaneous Nocardia asteroides infection in a patient with systemic lupus erythematosus. Case report

We report a case of acute primary cutaneous infection of traumatic origin caused by Nocardia asteroides, appeared as cellulitis in a patient with systemic lupus erythematosus. Diagnosis was established by direct examination and cultures from aspirate specimens. The clinical forms of Nocardia infections that affect the skin, reported in Rio Grande do Sul and Uruguay, are discussed.

Rhodococcus equi infection after reduction mammaplasty in an immunocompetent patient

The majority of infections caused by R. equi occur in hosts with some degree of cell-mediated immunodeficiency. Immunocompetent individuals are infrequently affected and usually present with localized disease. Infections of the skin or related structures are uncommon and are usually related to environmental contamination. The microbiology laboratory plays a key role in the identification of the organism since it may be mistaken for common skin flora. We describe a 31 year-old woman without medical problems who presented nine weeks after breast reduction with right breast cellulitis and purulent drainage from the surgical wound. She underwent incision and drainage, and cultures of the wound yielded Rhodococcus equi. The patient completed six weeks of antimicrobial therapy with moxifloxacin and rifampin with complete resolution.