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Brown recluse bite mimic — ABEM Board MCQ

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ModerateEnvironmental emergenciesBrown recluse bite mimicABEM Board

A 44-year-old man arrives with a painful red lesion on his thigh after hiking. Triage acuity is ESI 4; T 101.0 F, HR 104/min. Exam shows fluctuance with purulent drainage and surrounding cellulitis. He did not see a spider and lives outside the brown recluse range. Which of the following is the most likely diagnosis?

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Correct answer: B — Community-associated MRSA skin abscess

Purulent fluctuance and cellulitis without witnessed spider exposure is more consistent with bacterial abscess than spider bite.

Reference: IDSA skin and soft tissue infection guideline