All Journals from Patrick Lillie
Soft tissue infections with Scedosporium spp. are an uncommon but serious and emerging cause of infection in immunocompromised patients. Acute Medical Units (AMUs) in the UK are increasingly managing patients with cellulitis in an outpatient setting, therefore acute physicians should be aware of some of the more uncommon causes of soft tissue infection, particularly in patients not responding to initial antibiotic therapy. We present two cases of Scedosporium presenting to the AMU as cellulitis not responding to initial antibiotic therapy and outline the assessment and management of this important condition.
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Painful lymphadenopathy due to silicone breast implant rupture following extensive global air travel
Abstract
A 25-year-old Caucasian flight attendant with an extensive travel history presented with night sweats, fevers, weight loss and axillary and supraclavicular lymphadenopathy. Apart from surgical breast augmentation, she had no past medical or surgical history. She was anaemic, leucopenic and lymphopenic, and a broad infection screen was negative. Cross-sectional imaging revealed ipsilateral silicone breast implant rupture, with leaking of implant contents into the surrounding tissue. Histological examination of an axillary lymph node core biopsy confirmed the diagnosis of silicone
lymphadenopathy.
This case illustrates the broad differential for acute painful lymphadenopathy in the context of global travel, and the use of targeted infection testing, early cross-sectional imaging and biopsy to arrive at an unexpected diagnosis.
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Antimicrobial resistance is of increasing concern to patients, physicians and policy-makers alike. The challenge for the clinician at the coalface, however, is to avoid the undertreatment of seriously ill patients whilst minimising the evolution of antimicrobial resistance. Difficult decisions about the most appropriate antibiotic to prescribe can be supported by careful risk factor and prognostic assessment.
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