Pathology: cellulitis

What happens when the cirrhotic patient has evidence of lower extremity cellulitis, as in the image above?  Do you prescribe antibiotics (5-10 days) and send the patient home?  Here are some additional considerations…

The immunocompromised patient is at risk for an occult Staphalococcal bloodstream infection, so you should obtain blood cultures before starting antibiotics.  Also, evaluate for pedal edema; it will be more difficult to clear an infection from an edematous leg.  Use diuretics wisely. 

The prevalence of renal dysfunction during bacterial infection other than spontaneous bacterial peritonitis (SBP) in patients with liver cirrhosis is around 36%, and its development is related to the severity of the liver disease. Occurrence of irreversible renal dysfunction may affect the prognosis of these patients.

Check the toes and toenails for fungal infections, as this is a frequent nidus for lower extremity cellulitis.  Be cautious if you choose to treat a fungal infection here; these drugs are often hepatotoxic. 

For more on bacterial infection-related morbidity in cirrhosis, click on the link here:

http://www.ncbi.nlm.nih.gov/pubmed/17509025

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