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68-Year-Old Male with Painful Rash on Abdomen

Can you diagnose this case?

David L. Kaplan 2014 Series Editor @ University of Missouri – Kansas City School of Medicine

Signs and Symptoms

A 68-year-old male presented with a 4-day history of a 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 500mg of cephalexin four times a day for the last four days, but the condition has worsened.

Which is the correct course of action to be incorporated in his treatment?

Choose one to reveal diagnosis and discussion

Biopsy, incision and drainage, oral corticosteroid
Bacterial culture, change of antibiotic
Bacterial culture, incision and drainage, oral corticosteroid
Bacterial culture, incision and drainage, change of antibiotic
Incision and drainage, biopsy

Answer: Bacterial culture, incision and drainage, 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.

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