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HM14 Special Report: When Cellulitis Isn’t: Identifying Cellulitis Mimics

Presenter: Daniela Kroshinsky, MD, MPH

Summation: Cellulitis accounts for up to 10% of infectious disease hospitalizations and for about 3 billion/year in healthcare costs for both inpatient and outpatient treatment. Dr. Kroshinsky pointed out that dependent on patient factors, inadequately treated or recurrent cellulitis can lead to significant complications with chronic stasis changes and ulcerations. The diagnosis of cellulitis is typically made on physical exam. Cellulitis may have unusual presentations and at times the diagnosis can be difficult.

Hospitalists need to be aware that cellulitis has multiple mimics, and between 28% to 33% of patients are misdiagnosed as having cellulitis.

Dr. Kroshinsky listed a number of differential diagnoses. Frequent alternative diagnoses are dermatitis due to venous stasis or caused by lymphedema. Other skin conditions that need to be considered include erysipeloid, erythema migrans, atypical zoster, tinea and other fungal infections as well as skin changes caused by underlying malignancies.

Key Takeaways

  • The diagnosis of cellulitis has a high error rate
  • It is important to treat cellulitis adequately to prevent chronic skin changes and ulcers
  • If cellulitis does not respond to appropriate antibacterial treatment, consider alternative diagnoses
  • Be aware that many skin conditions can mimic cellulitis in immunocompromised patients

Klaus Suehler is a hospitalist at Mercy Hospital at Allina Health in Coon Rapids, Minn., and a member of Team Hospitalist.

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