Topics in Pediatrics
Cellulitis of the Knee in a 16-Month-Old Boy: A Case Report

https://doi.org/10.1016/j.jcm.2016.02.003Get rights and content

Abstract

Objective

The purpose of this case report is to describe the presentation of cellulitis in a 16-month-old boy to a chiropractic clinic.

Clinical Features

The patient presented with nontraumatic, sudden onset of nonpurulent erythema on the right knee. A plain film radiograph of the knee showed a 40-mm thickening of the anterior knee. A diagnosis of cellulitis was rendered based on the presentation of the rapidly spreading erythema and radiographically confirmed findings.

Intervention and Outcome

The patient was immediately referred to the local emergency room. The patient was hospitalized, treated with clindamycin and amoxicillin for 3 days, and then discharged. The patient’s pediatrician discontinued clindamycin treatment at the posthospitalization follow-up. Two weeks after treatment was discontinued, the patient was diagnosed with recurrent cellulitis.

Conclusion

This case demonstrated that for this young patient with cellulitis of the knee, timely recognition and referral, together with patient or parent education and immediate treatment, were essential to a successful outcome.

Introduction

Cellulitis is an infection of the skin and subcutaneous tissues that can spread rapidly. It is clinically diagnosed based on the presentation of a nonpurulent erythemic rash with irregular margins, edema, and local tenderness.1, 2, 3, 4, 5, 6, 7, 8

The most common presentation for cellulitis of the lower extremities is a secondary condition due to trauma, which is most commonly seen in sports-related trauma or trauma involving foreign bodies. Other common presentations are seen among patients with a body mass index higher than 31, geriatric patients, and patients with a history of diabetes or immune compromise.6, 9, 10, 11, 12, 13, 14

The presentation of cellulitis to a chiropractic clinic is not commonly reported in the literature. At present, only 1 case report exists which describes the presentation in an adolescent.5 Therefore, the purpose of this case report is to describe the presentation of cellulitis in a 16-month-old boy to a chiropractic clinic.

Section snippets

Case Report

An otherwise healthy 16-month-old boy presented to a chiropractic clinic with initial chief complaint of a “red, angry rash” on the right knee, as described by the patient’s mother.

The patient’s mother noticed the erythematous reaction during a diaper change on the morning of the visit but denied any noticeable erythematous rash, pyrexia, or skin markings on the day before the office visit.

The patient exhibited no signs of distress and no apparent guarding while walking. Patient’s medical

Discussion

Cellulitis is a skin infection of the subcutaneous tissues that is clinically diagnosed based on the presentation of a nonpurulent erythematic rash with striations and irregular margins, swelling, and local tenderness,1, 2, 3, 4, 11, 14, 17, 18, 25 as seen in this case. It also has the potential to spread rapidly to various regions of the body adjacent to the initial dermatologic outbreak. An infection that spreads through the fascia and skin could have detrimental consequences for a

Conclusion

Cellulitis of the knee is not a common site for a 16-month-old child. Most initial presentations could be dismissed as an allergic reaction, which would delay diagnosis and treatment in this case. Closer attention needs to be paid to the progression of any skin infection even when there is no history of trauma or insect bites, or if a compromised medical history is present. Fast recognition and referral to the ED, together with patient or guardian education and immediate care, are crucial to

Funding Sources and Conflicts of Interest

No funding sources or conflicts of interest were reported for this study. This case report is submitted as partial fulfillment of the requirements for the degree of Master of Science in Advanced Clinical Practice at the Lincoln College of Post-professional, Graduate, and Continuing Education at the National University of Health Sciences.

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