*Corresponding author:Jochanan E. Naschitz, Bait Balev Nesher and The Ruth and Bruce Rappaport Faculty of Medicine, Technion, Israel Institute of Technology, Haifa, Israel, Address: POB 252, Nesher 36602, Derech Hashalom 11; Telephone: 073-2-377-300; Fax: 97248345575; Email: Naschitz@technion.acil
Received: July 19, 2018; Published: July 30, 2018
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Erythema nodosum migrans was a challenging diagnosis in a 91-year-old woman. The disorder presented features of cutaneous and deep subcutaneous inflammation with a recurrent and migratory course. The extensive lesions were unresponsive to antibiotics as well as topical and systemic corticosteroid treatment. Awareness to this rare and confusing condition might allow for earlier diagnosis and treatment. Cellulitis is an acute spreading infection of the skin that also involves the subcutaneous tissues. Cellulitis and erysipelas are ‘nonculturable’ skin infections. Most cases of cellulitis are caused by beta-hemolytic streptococci. Patients typically develop high fever, chills, headache, vomiting and general symptoms within 48 hours of infection.
Local signs include skin erythema, warmth and tenderness in the affected area, but no distinctive anatomical demarcation as seen in erysipelas. Often cellulitis is confined to the calf. Culture of material aspirated from the involved skin is not routinely performed because of the low diagnostic yield. Likewise, only approximately 2% to 5% of blood cultures yield results. Cefazolin or oxacillin is often the initial treatment of choice for both erysipelas and cellulitis . The differential diagnosis of calf cellulitis also entails a gamut of non-infectious disorders . Here we report the history of an elderly patient who suffered during a 6 months period of atypical, migratory non-infectious cellulitis. Erythema nodosum migrans was finally diagnosed.