The FP diagnosed erysipelas. Erysipelas is a specific type of superficial cellulitis with prominent lymphatic involvement that leads to sharply defined and elevated borders. It is most often caused by β-hemolytic Streptococcus, but may also be caused by Staphylococcus aureus.
The classic treatment for erysipelas is systemic penicillin because of its excellent coverage of β-hemolytic Streptococcus. The route of administration—oral or IV—hinges on the severity of the case.
In light of a possible (mild) penicillin allergy, the physician treated the patient with oral cephalexin, which covers Streptococcus and methicillin sensitive S aureus. The FP discussed the pros and cons of hospitalization with the patient and they agreed that it was reasonable to start with oral outpatient therapy. The FP advised the patient to go to the emergency department if his condition worsened or if he was unable to hold down the oral medication.
At a 2-day follow-up appointment, the patient was afebrile and showed significant improvement. The patient finished the full 7-day course of the antibiotic without any complications.
Photo courtesy of Ernesto Samano Ayon, MD. Text for Photo Rounds Friday courtesy of Richard P. Usatine, MD. This case was adapted from: Usatine R. Cellulitis. In: Usatine R, Smith M, Mayeaux EJ, et al, eds. Color Atlas of Family Medicine. 2nd ed. New York, NY: McGraw-Hill; 2013:693-697.
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