An Infected Laceration

Dawd S. Siraj, MD, John A. Bartlett, MD, and Newton Hyslop, MD

Disclosures

Infect Med. 2002;19(2) 

In This Article

Introduction

A 44-year-old man presented to our emergency department (ED) for reevaluation of an infected leg wound. Two weeks before admission, he had fallen in his boat, sustaining a minor laceration to his right leg. During the next 2 days, the wound had become erythematous and swollen. He was evaluated in our ED and admitted for treatment of cellulitis. A wound culture obtained during this hospitalization grew Pseudomonas aeruginosa and Escherichia coli. The patient was treated with doxycycline and cefepime and discharged after 5 days of antibiotic therapy. Antibiotics were not continued after discharge. During the next week, the swelling and erythema worsened and was now accompanied by pain and low-grade fever.

At the time of hospitalization, the patient was unemployed. His history was negative for smoking, alcohol abuse, and injection drug use. His medical history revealed that he was hepatitis C antibody- and antigen-positive, but he was not thought to have chronic active liver disease. There were no known allergies, and he was taking no medications.

On physical examination, the patient appeared comfortable, well-nourished, and well-developed. His temperature was 36.5ºC (97.7ºF); respiratory rate, 20 breaths per minute; pulse, 75 beats per minute; and blood pressure, 145/75 mm Hg. Findings from his physical examination were within normal limits except for the right leg, where there was a deep ulcer measuring 8 3 10 cm with elevated margins and surrounding erythema. The entire right leg was swollen, and the area around the wound was tender to palpation. Exudate was noted at the ulcer site.

Laboratory tests on admission included a white blood cell count of 16,000/µL, with 85% granulocytes, 12% lymphocytes, and 3% monocytes. Hemoglobin level was 14.6 g/dL; hematocrit, 42.7%. Platelet count was 191,000/µL. Blood urea nitrogen level was 17 mg/dL; creatinine, 0.7 mg/dL. Levels of liver enzymes, bilirubin, and albumin were within normal limits. Blood and wound cultures were obtained.

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