RESUMO
BACKGROUND: Cellulitis is a significant public health burden and lacks a gold standard for diagnosis. Up to 1/3 of patients are incorrectly diagnosed. The skin biopsy has been proposed as the gold standard. OBJECTIVE: In this study, we evaluate the histopathologic characteristics and tissue culture positivity of biopsies in patients diagnosed with cellulitis seen by our inpatient dermatology consultation service. METHODS: This retrospective cohort study examined patients who were hospitalized with a skin and soft tissue infection at our institution between 2011 and 2020 and underwent a skin biopsy. RESULTS: Those with a positive tissue culture were more likely to die within 30 days compared with those with negative tissue cultures (26% vs. 6%, P = 0.048). Patients who died within 30 days were more likely to have acute interstitial inflammation as a feature on histopathology (38%, P = 0.03). LIMITATIONS: Single institutional design, unintentional exclusion of patients with organism-specific diagnosis, and selection for a medically complex patient population because of the nonroutine collection of biopsies. CONCLUSION: Positive tissue cultures and histopathology showing acute interstitial space inflammation on skin and soft tissue infection (SSTI) biopsies are associated with increased mortality and thus may serve as indicators of poor prognosis.
Assuntos
Celulite (Flegmão) , Pele , Humanos , Celulite (Flegmão)/patologia , Celulite (Flegmão)/diagnóstico , Celulite (Flegmão)/mortalidade , Estudos Retrospectivos , Masculino , Feminino , Pessoa de Meia-Idade , Biópsia , Idoso , Prognóstico , Pele/patologia , Adulto , Doença Aguda , Infecções dos Tecidos Moles/patologia , Infecções dos Tecidos Moles/mortalidade , Infecções dos Tecidos Moles/diagnóstico , Técnicas de Cultura de Tecidos , Idoso de 80 Anos ou maisRESUMO
Symmetrical drug-related intertriginous and flexural exanthema (SDRIFE) is classically considered a low-risk, self-limiting eruption lacking systemic manifestations and sparing facial and mucosal areas. We present 7 inpatients meeting diagnostic criteria for SDRIFE with concomitant systemic manifestations ± high-risk facial involvement acutely after antibiotic exposure (mean latency 6.71 days). These cases deviate from classic, self-limited SDRIFE and represent a unique phenotype of SDRIFE, characterized by coexisting extracutaneous manifestations. Onset of systemic stigmata coincided with or preceded cutaneous involvement in 4 and 3 patients, respectively. All patients developed peripheral eosinophilia and 6 patients had ≥ 2 extracutaneous systems involved. Facial involvement, a high-risk feature associated with severe cutaneous adverse reactions but atypical in classic SDRIFE, occurred in 4 cases. Patients had favorable clinical outcomes following drug cessation and treatment with 4-6 week corticosteroid tapers. We suggest that baseline labs be considered in hospitalized patients with antibiotic-induced SDRIFE. These patients may also necessitate systemic therapy given extracutaneous involvement, deviating from standard SDRIFE treatment with drug cessation alone.
Assuntos
Antibacterianos , Toxidermias , Exantema , Fenótipo , Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Exantema/induzido quimicamente , Exantema/diagnóstico , Antibacterianos/efeitos adversos , Toxidermias/etiologia , Toxidermias/diagnóstico , Toxidermias/patologia , Idoso , Adulto , Hospitalização/estatística & dados numéricos , Eosinofilia/diagnóstico , Eosinofilia/induzido quimicamenteAssuntos
Hospitalização , Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Adulto , Idoso , Epidermólise Bolhosa/terapia , Epidermólise Bolhosa/diagnóstico , Adulto Jovem , AdolescenteRESUMO
This cohort study examines patients with drug reaction with eosinophilia and systemic symptoms who also have pustules.