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Severe cellulitis with systemic features — RACP Adult Medicine MCQ

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ModerateDermatologySevere cellulitis with systemic featuresRACP Adult Medicine

A 58-year-old man with diabetes has rapidly spreading painful lower-leg erythema, fever and lymphangitis. He is tachycardic but normotensive. There is no crepitus, necrosis or water exposure. What is the most appropriate management?

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Correct answer: A — Admit for intravenous anti-staphylococcal and anti-streptococcal antibiotics with limb elevation

Systemic features with spreading cellulitis warrant hospital assessment, IV antibiotics covering streptococci and staphylococci, and supportive measures. Topical steroid and antifungal monotherapy do not treat bacterial cellulitis. DVT can mimic cellulitis but does not explain fever and lymphangitis, and antibiotics should not wait for positive blood cultures.

Reference: Therapeutic Guidelines (eTG) Antibiotic; AMH