chief complaint of pain, redness, and swelling of his right calf. He states that he had been working in his yard using a string trimmer when the trimmer slipped and cut his leg. He cleaned the wound with water from the garden hose and covered the wound with a large Band-Aid. Several days later, he developed fever to 100.6˚ F and chills and noticed that his leg was swollen and red. He comes to the emergency department for definitive care.

Title: A Case Study on Cellulitis: Evaluation and Management

Introduction:
This case study focuses on a patient presenting with pain, redness, and swelling in his right calf. The patient reports sustaining a cut while using a string trimmer in his yard and subsequently self-treated the wound. However, following several days, he developed fever, chills, and worsening symptoms in his leg. This case highlights the importance of timely diagnosis and appropriate management of cellulitis.

Background:
Cellulitis is a common bacterial skin and soft tissue infection characterized by inflammation and erythema. It commonly occurs as a result of a break in the skin, such as a cut, scrape, or an insect bite, allowing pathogens to enter the underlying tissues. Common causative organisms include Streptococcus pyogenes and Staphylococcus aureus. Patients may present with local symptoms, including pain, heat, swelling, and redness, accompanied by systemic signs such as fever and chills.

Evaluation:
The evaluation of a patient with suspected cellulitis involves a comprehensive history and physical examination. Factors such as the timing and mechanism of injury, subsequent wound care, and symptoms progression are important to assess. In this case, the patient reported sustaining a cut on his leg while using a string trimmer. He initially cleaned and covered the wound with a large Band-Aid. Subsequent symptoms, namely fever, chills, increased swelling, and redness, are concerning for a progression of infection.

Physical examination findings are crucial in determining the severity and extent of cellulitis. The affected area is typically warm, tender, and demonstrates erythema. In more severe cases, there may be edema, induration, lymphadenopathy, and purulent drainage. Establishing the involvement of surrounding structures, such as joints or deep tissues, is essential to guide appropriate management.

Differential Diagnosis:
While cellulitis is a likely diagnosis in this case, it is important to consider other conditions that can present with similar symptoms. Deep vein thrombosis (DVT) is one such differential, particularly given the patient’s leg swelling. DVT can cause calf pain, redness, and swelling and may require further investigation with imaging studies such as ultrasound. Other differentials to consider include varicose veins, erysipelas, and necrotizing fasciitis.

Management:
Cellulitis management involves a combination of empiric antibiotic therapy, wound care, pain management, and patient education. The choice of antibiotics should be guided by local antibiotic resistance patterns and patient factors such as allergies and comorbidities. Empiric therapy typically covers both Streptococcus pyogenes and Staphylococcus aureus, with first-line options including Cephalexin or Dicloxacillin. In more severe cases or patients with risk factors, broad-spectrum antibiotics such as Clindamycin or Vancomycin may be warranted.

Appropriate wound care includes cleansing the wound with mild soap and water, removing any foreign bodies, and ensuring adequate drainage. Irrigation with normal saline solution or sterile water may be necessary to remove debris. In some cases, incision and drainage (I&D) may be required for abscesses or areas of fluctuance. Pain management can be achieved with over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs) or mild analgesics.

Patient education is vital to prevent future infections and complications. The patient should be advised to keep the wound clean and dry, change dressing regularly, and avoid further trauma to the area. Additionally, signs of worsening infection, such as spreading redness, increasing pain, or persistent fever, should be reported promptly.

Conclusion:
Timely evaluation and appropriate management of cellulitis are essential to prevent complications and ensure optimal patient outcomes. This case underscores the importance of considering cellulitis as a differential diagnosis in patients presenting with pain, redness, and swelling, particularly following an inciting injury. Clinicians should carefully evaluate the wound and surrounding structures, choose appropriate antibiotics, and provide comprehensive wound care and patient education to promote effective healing and prevent recurrence.