Infectious — Skin

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Case 1 of 8InfectiousSkin (e.g., abscess, impetigo, tinea versicolor)

A 29-year-old mountain climber presented to the ER. He was descending from one of his climbs 1 week ago when he had a fall and hurt his left lateral thigh on a rocky surface. He got a 2x2 cm deep, contaminated wound at the site of the fall. He used regular first aid, cleaned the wound, and continued his descent with the help of his fellow climbers; he did not seek any additional wound care at the time, and his last tetanus booster was more than 10 years ago. Since the last 2 days, the pain in his thigh has gotten worse and he has developed a fever. On examination BP: 110/80, Temp: 101°F, RR: 14, HR: 105. His left lateral thigh, just above the knee, is erythematous and swollen.

Question 1 of 21

What investigations would you do first?

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APlain radiograph of the thigh alone

BPunch skin biopsy of the erythematous area for histopathology

CMRI of the thigh with gadolinium as the initial test

DImmediate surgical exploration of the wound without any labs or imaging

ECBC, CRP/ESR, wound swab culture (if draining), and bedside ultrasound of the thigh to evaluate for an underlying abscess or deep fluid collection; blood cultures are not routinely required for mild-to-moderate cellulitis but can reasonably be considered given this patient's systemic signs (fever, tachycardia)

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