What conditions should be considered in the differential diagnosis of cellulitis or in cases of treatment failure?

Updated: Jun 14, 2019
  • Author: Thomas E Herchline, MD; Chief Editor: Michael Stuart Bronze, MD  more...
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Diagnostic studies are generally unnecessary in uncomplicated cellulitis, and most cases respond well to standard antibiotic regimens. If there is no response to the initial choice of antibiotic, the organism may be resistant to the drug. Also, consider unusual organisms that may require combinations of antibiotics. Finally, consider an alternative diagnosis that might be commonly confused with cellulitis.

Other conditions that should be considered include the following:

  • Myonecrosis

  • Calciphylaxis

  • Cutaneous anthrax

  • Cutaneous metastasis from neoplasms (especially adenocarcinoma)

  • Envenomation by puncture with spines of stonefish (in the South Pacific)

  • Inflammatory carcinoma of the breast or other cutaneous malignancy

  • Neutrophilic eccrine hidradenitis

  • “Seal finger” secondary to seal bites (in aquarium workers and veterinarians) [63]

  • Sweet syndrome [64]

  • Tumor necrosis factor receptor­-associated syndrome

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