A 27-year-old woman was petting her cat, when the animal suddenly bit her on the arm. She immediately rinsed copiously with isopropyl alcohol and applied an over-the-counter antibiotic ointment. However, 12 hours later a large, red, swollen, and exquisitely tender plaque had developed around the bite site (Figure). There was purulent drainage at the bite site. The patient was being treated for Crohn disease, receiving periodic infliximab infusions and taking 6-mercatopurine. The remainder of the medical history, as well as social and family histories, were unremarkable. The patient calls you for advice. What would be the best thing to do?
A. Call in a prescription for 7 days of oral cephalexin
B. Reassure her that this is a normal response to toxins in cat saliva and suggest frequent warm tap water soaks and oral NSAIDs, as needed, for pain
C. Call in a prescription for oral cephalexin and recommend frequent warm tap water soaks
D. Tell her to take the cat to the local public health department immediately for quarantined observation for rabies
E. Tell her to report to the nearest ED, with anticipation of hospitalization for parenteral antibiotics and surgical consultation
1. Kwo S, Agarwal JP, Meletiou S. Current treatment of cat bites to the hand and wrist. J Hand Surg. 2011;36:152-153.
2. Benson LS, Edwards SL, Schiff AP, et al. Dog and cat bites to the hand: treatment and cost assessment. J Hand Surg. 2006;31:468-473.
3. Lewis KT, Stiles M. Management of cat and dog. Am Fam Physician. 1995;52:479-485.
4. Talan DA, Citron DM, Abrahamian FM, et al. Bacteriologic analysis of infected dog and cat bites. N Engl J Med. 1999;340:85-92.
5. Abrahamian FM, Goldstein EJC. Microbiology of animal bite wound infections. Clin Microbiol Rev. 2011;24:231-246.
6. Griego RD, Rosen T, Orengo IF, et al. Dog, cat, and human bites: a review. J Am Acad Dermatol. 1995;33:1019-1029.
7. Freshwater A. Why your housecat's trite little bites could cause you quite a fright: a study of domestic felines on the occurrence and antibiotic susceptibility of Pasteurella multocida. Zoonoses Public Health. 2008;55:507-513.
8. Blanton JD, Robertson K, Palmer D, et al. Rabies surveillance in the United States during 2008. J Am Vet Med Assoc. 2008;235:676-689.