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cellulitis, inelastic compression, infrared thermometry, Levine culture technique, lipodermatosclerosis, venolymphedema, wound management



  1. Maida, Vincent MD, MSc, BSc, CCFP(PC), FCFP, ABHPM
  2. Cheung, Joyce T. W. MD, BSc, CCFP


BACKGROUND: Patients with erythematous skin are likely to receive a diagnosis of cellulitis; however, the accuracy of this diagnosis is approximately only 33%. The diagnosis of cellulitis should be made only after a thorough evaluation of all possible differential diagnoses. Cellulitis may be a primary process (superficial spreading infective process involving only the epidermis and dermis) versus a secondary (reactive) process incited by a subcutaneous process, such as an abscess, tenosynovitis, necrotizing fasciitis, and osteomyelitis.


CASE PRESENTATION: A 50-year-old man was admitted to a general hospital with the diagnosis of cellulitis. He was initially treated with systemic antibiotics without improvement. Following consultation with a wound management physician, the patient received a diagnosis of a pretibial abscess and was treated with surgical evacuation and postoperative systemic antibiotic therapy guided by tissue cultures. A postoperative wound was successfully treated with inelastic compression therapy.


CONCLUSIONS: This case demonstrates the potential for misdiagnosis when evaluating erythematous skin. Furthermore, concluding that the erythema is due to a primary cellulitis may result in monotherapy with systemic antimicrobial agents. In such cases, making a correct diagnosis through a skillful and complete physical examination of the patient, coupled with appropriate investigations, will lead to the best possible outcome. A comprehensive treatment approach may include systemic antimicrobials, as well as surgical options and compression therapy.