Cellulitis with Abscess Formation in Healthcare Worker

Case at a Glance

A 31-year-old female ICU nurse presented with a progressive skin lesion on her upper thigh, initially suspected to be an insect bite, which developed into cellulitis with possible abscess formation over one week.

Patient's Story

The patient, a healthcare worker with high pathogen exposure, noticed what appeared to be a large insect bite on her upper thigh upon waking one week prior. She marked the borders to monitor progression. Despite conservative management with ice and ibuprofen, the lesion became increasingly painful, erythematous, and warm to touch, with purulent drainage developing. The patient expressed concern about the worsening nature and timeline of the lesion.

Initial Assessment

Physical examination revealed an inflamed lesion on the upper thigh with surrounding erythema, warmth, tenderness, and purulent discharge. The patient had outlined the lesion borders, which showed expansion over the monitoring period. Vital signs were stable, and the patient appeared systemically well.

The Diagnostic Journey

Given the patient's healthcare worker status and high pathogen exposure, differential diagnosis included bacterial cellulitis, abscess formation, or healthcare-associated infection. The progressive nature, local inflammatory signs, and purulent drainage suggested bacterial skin and soft tissue infection rather than a simple insect bite reaction.

Final Diagnosis

Cellulitis with early abscess formation, likely bacterial etiology. Culture would be needed to identify specific pathogen and guide targeted antibiotic therapy.

Treatment Plan

Recommended evaluation by primary care physician or emergency department for assessment of systemic involvement. Treatment plan to include wound culture, empirical antibiotic therapy, and consideration for incision and drainage if abscess is confirmed. Given healthcare worker status, coverage for resistant organisms may be warranted.

Outcome and Follow-up

Patient advised to seek prompt medical attention given progression despite conservative measures. Follow-up planned based on culture results and response to treatment. Return precautions provided for signs of systemic infection or worsening local symptoms.