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Adviser
dr. Amru Sungkar, Sp.B, Sp.BP-RE
Phoenix et al (2012)
• Cellulitis is an acute, spreading,
pyogenic inflammation of the lower
dermis and associated subcutaneous
tissue.
Wingfield, Carrie (2009)
Infecting organism
Pathogenesis penetrated the
8
integumentary barrier
Bacterial Invasion of
Elaboration of
adherence to tissue & evasion
toxins
host cells of host defences
endotoxin exotoxin
Lipopolysaccharidae
Actively secreted
chain found in
proteins that cause
bacterial gram
tissue damage
negative cell wall
Microbial
Infection induce host invasion/tissue
response: damage changes
inflammation vascular tone -> blood
flow ↑
Cell phagocytize
Extravasation of
Inflammation plasma protein &
destroy foreign
6 leukocytes
matter, dead tissue or
microbes
Certain pyrogenic
cytokines or exotoxin
cause the febrile
response
Cardinal Ancillary systemic
manifestations: signs: fever,
warmth, erythema, hypotension,
Clinical edema, pain and tachycardia
manifestations dysfunction
of The release of
inflammation6 cytokines mediated
by normal immune
cell function/toxin
stimulation
Cardinal signs of inflammation
Histopatologic examination9
Name : Mrs. W
Age : 50 years old
Job : Chef
Address : Kalimantan
Date of examination : November 4th, 2015
Reg numb : 0131xxxx
Chief Complaint
• Appears boil in the • Appears boil in the • Patient’s limb was • The swollen was
right hand, after right leg and the swollen bigger than before,
several days appears patient also • Not yet red and feels began to appear
eye ulcer and the complained of pain hot eritema and feels
patient massaged it in the stomach hot
so the pus could • The patient went to • Patient transferred
come out Pangkalan Bun to Moewardi
Hospital Hospital with
• In the hospital, her suspected DVT
blood sugar was 345 • Cardiology
mg/dl, blood department denied
pressure was it, so the patient
170/110mmHg consulted to
• The patient was Dermatovenerology
treated by department with
neurologist and suspected Cellulitis
internist
Past illness
Same illness : denied
DM : denied, but the bloo sugar
was 345 mg/dl, HbA1c was
7,1%
HT : (+)
Food and drug allergy : denied
Family history
Same illness : denied
Food and drug allergy : denied
DM : denied
HT : denied
Physical examination
General state :Somnolent
Vital sign : BP: 120/80 mmHg, HR: 88 x/11, RR : 35x/1’ , T : afebrile
Cephal : normal
Neck : normal
Eyes : normal
Abdomen : normal
Thorax : normal
Back : normal
Supor Extremity : normal
Infor extremity : see dermatology status
Genitalia : normal
Dermatology status erythema
edema
pain
Borders are
diffuse and ill
defined
Borders
aren’t raised
Yellow Peau d’
Crusted orange
Dermatology status erythema
edema
pain
Borders are
diffuse and ill
defined
Borders
aren’t raised
Peau d’
orange
Differential diagnosis
Cellulitis
Erysipelas
Laboratory examination
Gram staining: PMN 0-1/LPB
coccus gram (+) 50-70/LPB
Working diagnosis
Cellulitis
Treatment
Non medical :
Leg elevation 300 to reduce edema
Keep hygiene and immune status
Medical :
Compress with NaCl 0.9% 2x15’
Topical: antibiotic zalf (fusidic acid cream 2%)
twice/day
Azytromycin 500mg / day Per Oral
Prognosis
Ad vitam : dubia
Ad sanam : dubia
Ad fungsionam : dubia
Ad cosmeticam : dubia
1. Phoenix et al. Diagnosis and Management of Cellulitis.
Referrences Site of Care. The 2007 CJIDMM Trainee Review Article Award. 2008;
173-184.
7. DiNubile MJ, Lipsky BA. Complicated Infection of Skin and Skin
Structures: When The Infection is More Than Skin Deep. Journal of
Antimicrobial Chemotherapy. 2004; ii37-ii50.
8. Blauvelt A. Cellulitis. Dalam: Wolff K, Goldsmith LA, Katz
SI,Gilchrest BA. Paller AS, Leffell DJ, penyunting. Fitzpatrick’s
Dermatology in General Medicine. Edisi ke-7. New York: McGraw Hill
Companies; 2008. h. 1721, 1727.
9. Stevens DL et al. Practice Guidelines for the Diagnosis and
Management of Skin and Soft Tissue Infection: 2014 Update by The
Infectious Disease Society of America. Clinical Infectious Disease
Advance Acess. 2014; 1-4
10. Keeley, et al. Management Cellulitis in Lymphoedema. The
Lymphoedema Support Network. 2010;1-10
THANK YOU