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Cellulitis in Lymphoedema Diagnosis — SCE Palliative Medicine MCQ

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HardPain ManagementCellulitis in Lymphoedema DiagnosisSCE Palliative Medicine

A woman with chronic arm lymphoedema after axillary clearance develops a rapidly expanding, tender erythematous area, increased limb swelling, rigors and a C-reactive protein of 126 mg/L. There is no palpable cord, venous duplex is negative and no focal mass is present. What is the most likely diagnosis?

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Correct answer: A — Acute cellulitis complicating the lymphoedematous arm

Explanation lettering: D = shown as A · A = shown as C · C = shown as D

D is correct. Rapid tender erythema, warmth, systemic upset, inflammatory-marker rise and acutely increased swelling are typical of cellulitis in a lymphoedematous limb. A usually causes progressive rather than febrile inflammatory swelling. B more often produces violaceous or haemorrhagic papules or nodules rather than an acute septic syndrome. C is usually pruritic and patterned to exposure without rigors or marked systemic inflammation. E is weakened by the negative duplex and does not best explain the expanding cutaneous inflammatory change.

Reference: NHS Highland: cellulitis in patients with lymphoedema: https://www.rightdecisions.scot.nhs.uk/tam-treatments-and-medicines-nhs-highland/adult-therapeutic-guidelines/lymphoedema/cellulitis-in-patients-with-lymphoedema-guidelines/