Unexplained Severe Cervical Cellulitis in Previously Healthy Adult

Case at a Glance

A 41-year-old healthy male presented with severe neck cellulitis of unknown origin, requiring 5-day hospitalization and IV antibiotic therapy, with no identifiable risk factors or obvious portal of entry.

Patient's Story

The patient initially experienced what he perceived as neck stiffness upon awakening. Having no significant medical history and maintaining an active lifestyle with regular exercise, he initially dismissed the discomfort as muscular strain. Over the following 5 days, the pain progressively intensified to an unbearable level, prompting him to seek medical attention. The patient reported no recent trauma, injections, or obvious skin breaks in the affected area, though acknowledged possible minor insect bites or small abrasions that he considered routine for his active outdoor lifestyle.

Initial Assessment

Physical examination revealed signs consistent with cellulitis in the cervical region. Laboratory studies showed elevated inflammatory markers prompting immediate hospitalization. The patient appeared systemically unwell with localized erythema, warmth, and tenderness in the neck area. No obvious portal of entry was identified during examination.

The Diagnostic Journey

Blood cultures and inflammatory markers were obtained to assess for systemic involvement. Imaging studies were likely performed to evaluate the extent of soft tissue involvement and rule out deeper infections or abscesses. The patient's lack of traditional risk factors (diabetes, immunocompromise, IV drug use) made the case particularly puzzling, requiring thorough evaluation for underlying predisposing conditions.

Final Diagnosis

Severe cellulitis of the neck/cervical region without bacteremia. Despite extensive evaluation, no clear portal of entry or predisposing factor was identified, representing an idiopathic case of cellulitis in an otherwise healthy individual.

Treatment Plan

The patient received 5 days of intravenous antibiotic therapy during hospitalization, followed by a 20-day course of oral antibiotics (amoxicillin-clavulanate combination). The treatment successfully prevented systemic spread and achieved local control of the infection.

Outcome and Follow-up

The patient responded well to antibiotic therapy with resolution of acute symptoms and no progression to bacteremia. He was educated about wound care, early recognition of infection symptoms, and advised to seek prompt medical attention for any concerning skin changes. Long-term prognosis is excellent with low risk of recurrence given the absence of identifiable risk factors. Patient counseling addressed his concerns about susceptibility to future infections, emphasizing that cellulitis can occur in healthy individuals through minor skin breaches and that prompt treatment prevents severe complications.