Diagnosed With Recurrent Cellulitis – Painful Red Shin On A Diabetic
78 yo male with very well controlled diabetes, A1C of 7.1. On metformin 1g BID for past 4 years, diet controlled for past 9 years. Very active, healthy, BMI of 24.5. No other medical conditions. Has been on an ASA for past decade. Presents to urgent care with painful red left shin after trauma to the area. Hx of this 3 other times since 2009, last 2 episodes in 2014. All presented the same and were diagnosed with cellulitis. Was given bacitracin topical for the 1st and 3rd episodes and trimethoprim/sulfamethoxazole for the 2nd episode. This trauma occurred 5 days ago when he hit the shin on a dresser. Got slight bruising but then on the 2nd day developed swelling, some redness, redness has slightly spread downward, no fevers, moderate tenderness and minimal swelling of the left shin and foot. No fevers or chills.
Vitals unremarkable. Temp 98.5 oral.
Left shin about 5cm diameter erythema with central ecchymosis.
No groin lymphadenopathy.
Erythema blanches with no red base.
Skin is not indurated.
Slight edema of the midshin down to the top of the left foot.
Normal distal pulses.
Normal distal sensation.
Swelling with bruising and redness.
Area of redness with tenderness.
Erythema is moving distal not traveling proximally.
Ecchymosis with erythema.
Patient was not treated with antibiotics. Told to apply topical steroid cream, OTC hydrocortisone 1%. The important distinction here is that the erythema has no induration, he has no fever, the erythema is no traveling proximally but causing edema distally. He reports similar sxs with the other episodes. The hx of diabetes is a risk factor and so is his extensive varicosity but there is no significant signs of PVD.
Diagnosis: erythema due to ecchymosis.
Treatment: topical low potency steroid.
Outcome: patient reports less pain and much improved erythema after 3 days of topical steroid.