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68-Year-Old Male with Painful Lower Abdomen Rash

Can you diagnose this case?

David L. Kaplan, MDSeries Editor

Signs and Symptoms

A 68-year-old male presented with a 4-day history of worsening painful rash on his lower abdomen. He had been in the hospital in the last 10 days for a partial colon resection for colon cancer—with an abdominal incision higher up on the abdomen. The inflamed nodule is not part of surgical incision but is located within the surgical field that was shaved. He has been treated with cephalexin 500 mg 4 times a day for the last 4 days, but the condition has worsened.

Which of these options should be incorporated in his treatment?

Choose one to reveal diagnosis and discussion

Recommend a bacterial culture
Recommend an incision and drainage
Recommend changing the antibiotic to cover resistant strains
Recommend a biopsy to evaluate metastatic colon cancer
Recommend an oral corticosteroid taper to reduce inflammation

ASNWER: Bacterial culture, incision and drainage, and change of antibiotic

See the full case at Consultant360

A bacterial culture confirmed the clinical suspicion of methicillin-resistant Staphylococcus aureus, which responded to an incision and drainage and a changing of the antibiotics. While an incision and drainage is usually sufficient in uncomplicated cases, the recent surgery probably contributed to the introduction of the Staph infection by introducing micronicks into the skin. The rapid spread and presence of pain reduces the likelihood of metastatic cancer. Treatment should include the nares for the presumed site of the Staph carrier. Oral corticosteroids would not be indicated with this presentation.