Streptococcal Cellulitis of the Leg

September 14, 2005
Robert P. Blereau, MD

A 71-year-old man, who had recently returned from a month in Europe, complained of left lower leg swelling and pain of 1-week's duration. For many years, this obese patient had chronic venous insufficiency of both legs and chronic osteoarthritis of the knees that severely limited his ability to walk. The patient was admitted to the hospital with extensive cellulitis of the left lower leg.

A 71-year-old man, who had recently returned from a month in Europe, complained of left lower leg swelling and pain of 1-week's duration. For many years, this obese patient had chronic venous insufficiency of both legs and chronic osteoarthritis of the knees that severely limited his ability to walk. The patient was admitted to the hospital with extensive cellulitis of the left lower leg.

Robert P. Blereau, MD of Morgan City, La, reports the patient's temperature was 38.9°C (102°F); blood pressure, 90/40 mm Hg; pulse rate, 94 beats per minute; and urine output, 10 mL per hour. A blood culture grew Streptococcus agalactiae, a group B species that was sensitive to most antibiotics tested.

Intravenous cefazolin, dopamine, and intravenous fluids to maintain blood pressure and urine output were initiated. After 3 days, bullae developed over the entire left lower leg; complete superficial ulceration of the lower extremity followed.

The patient was transferred to a tertiary care facility, where hyperbaric oxygen therapy was added to the intravenous antibiotics and general supportive care. He was released from the hospital after 1 month of treatment. Lower leg care-including soaks, compression stockings, and elevation-continued at home until the leg healed 6 weeks later.