Internal Medicine

P1: OXT/OZN/JDO P2: PSB

0521779407-E-01 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 21:10

Erysipelas and Cellulitis Erythema Multiforme Major 545

specific therapy

■Administer antibiotics

➣Penicillin

➣Cephalosporin

➣Other – erythromycin, vancomycin, clindamycin

■Consider drainage if the area is fluctuant

■Treat associated onychomycosis if present to prevent recurrent dis-

ease

follow-up

During Rx

■Patients are often hospitalized; if not, they should be re-evaluated

daily.

complications and prognosis

■Recurrent cellulitis (or erysipelas) may occur due to disruption of

the lymphatic flow.

■Good prognosis, if treated early

ERYTHEMA MULTIFORME MAJOR; AKA STEVENS

JOHNSON SYNDROME (SEE ALSO DRUG ERUPTIONS)

RAJANI KATTA, MD and JEFFREY P. CALLEN, MD

history & physical

History

■Most cases related to drug ingestion

■Major offenders: antibiotics (penicillins, sulfonamides, cephalo-

sporins), anticonvulsants (phenytoin, carbamazepine, phenobarbi-

tal, lamotrigine), NSAIDS, allopurinol

■Minority of cases may be infection-related (mycoplasma pneumo-

niae, herpes simplex).

Signs & Symptoms

■Nonspecific prodrome precedes rash (1–14 days) in majority of

patients.

➣Fever, malaise, myalgias, arthralgias, headache, sore throat,

cough, rhinitis, diarrhea

■Pain, burning of mucous membranes

■Pain, tenderness of skin