SHM Converge Scientific Abstract ePoster Gallery-A Red Herring After Spring Break

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A 21-year-old woman presented with 2 days of right leg pain and swelling after a jet ski fall 3 weeks earlier that caused bruising but no open wound. Her exam showed a 3 cm erythematous, edematous area on the right anterior shin without bullae or pustules. Labs revealed marked leukocytosis (WBC 21.6 with left shift), normal CRP initially, and a positive beta-hCG indicating early pregnancy.<br /><br />She was initially treated as cellulitis and her antibiotics were broadened, including coverage for possible aquatic organisms, but her condition worsened despite therapy. The lesion expanded, she developed persistent fevers, rising leukocytosis and CRP, and imaging suggested a developing collection. Incision and drainage produced pus, but cultures remained negative. Because of the atypical course, a dermatology evaluation and punch biopsy were performed. Histopathology showed dense neutrophilic inflammation consistent with an acute febrile neutrophilic dermatosis, specifically Sweet syndrome. Clinically, the lesion also had features concerning for pyoderma gangrenosum (PG), leading to a PG/Sweet syndrome overlap diagnosis. Her presentation was felt to be triggered by early pregnancy.<br /><br />She improved dramatically after treatment with IV Solumedrol.<br /><br />This case highlights the importance of recognizing cellulitis mimics, especially when a patient worsens despite appropriate antibiotics. More than 10% of presumed cellulitis cases are ultimately due to another process. In atypical or refractory cases, early dermatology consultation and consideration of biopsy can help prevent misdiagnosis, prolonged hospitalization, readmission, and morbidity. Sweet syndrome and pyoderma gangrenosum are rare but important noninfectious mimics that should be considered when the clinical course does not fit uncomplicated cellulitis.

Asset Subtitle

Katherine Oakden

Meta Tag

Author List Felicia R. D’Souza, Katherine Oakden, Michele Fang, Nicole Tuyahov

Category Clinical Vignettes

Concept Cellulitis

Concept Cellulitis Mimic

Concept Sweet Syndrome

Concept Pyoderma Gangrenosum

Concept Alternative Diagnosis

Distinguished Non-Finalist

Presenter Organization University of Pennsylvania

Presenting Author Katherine Oakden

Track Adult

Keywords

cellulitis mimic

Sweet syndrome

pyoderma gangrenosum

neutrophilic dermatosis

pregnancy trigger

right leg swelling

leukocytosis

negative cultures

dermatology biopsy

IV Solumedrol

Cellulitis

Cellulitis Mimic

Sweet Syndrome

Pyoderma Gangrenosum

Alternative Diagnosis