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Cat Nip in an Immunocompromised Owner

Poll

A large, red, tender plaque developed after a cat bite in a woman with Crohn disease. What now?

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. The patient was being treated for Crohn disease. She calls you for advice.

What is the most prudent step?

Prescribe 7 days of oral cephalexin.
Prescribe oral cephalexin and warm water soaks.
Prescribe warm water soaks and NSAIDs PRN.
Send her to the ED (likely hospitalization for parenteral antibiotics and surgical consultation).
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