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Migratory cellulitis: Stenotrophomonas maltophilia infection of the skin
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  1. Sho Fujiwara1,2 and
  2. Yuji Gokon1
  1. 1Department of Surgery, Iwate Prefectural Tono Hospital, Tono, Iwate, Japan
  2. 2Department of Surgery, Iwate Prefectural Chubu Hospital, Kitakami, Iwate, Japan
  1. Correspondence to Dr Sho Fujiwara; sho.fujiwara{at}med.tohoku.ac.jp

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Description

An 87-year-old woman visited our hospital with an abscess in her left little finger that developed following an injury during a fall in the garden in the rain a few days ago. Physical examination revealed localised redness and swelling of the left hand (figure 1) and unremarkable findings in the left upper extremity. X-ray imaging showed no fractures. We treated the patient with incisional drainage and 1 g cefazolin intravenously every 8 hours for 7 days for the abscess and cellulitis in her left hand, respectively. The skin infection improved immediately (figure 2). However, 4 days after treatment initiation, the patient experienced migratory cellulitis of the left upper extremity without inflammatory signs in her left hand (figure 3). Tissue culture revealed Stenotrophomonas maltophilia. The patient was diagnosed with S. maltophilia infection, and her treatment was switched to a 5-day course of cotrimoxazole, following which the migratory cellulitis disappeared and the patient recovered.

Figure 1

Localised redness and swelling of the left hand.

Figure 2

The skin infection improved immediately with incisional drainage and cefazolin, respectively.

Figure 3

Migratory cellulitis of the left upper limb after treatment with cefazolin.

S. maltophilia infection of the skin in a patient who is not immunocompromised is very rare.1–3 S. maltophilia is an aerobic Gram-negative bacteria and motile by its flagella.4 It produces some extracellular enzymes: hyaluronidase, protease, elastase, lipase, DNase, RNase and fibrinolysin.4 A previous report suggested these enzymes contribute to its pathogenicity.5 These features of toxicity could cause migratory satellite cellulitis lesions. Even in a patient who is not immunocompromised and not at a high risk for skin infection, detailed history of injury and identification of characteristic skin lesions are important to accurately diagnose this infection.

Learning points

  • Stenotrophomonas maltophilia infection of the skin in a non-immunocompromised patient is very rare.

  • Detailed history of injury and identification of characteristic skin lesions are important in the diagnosis.

Acknowledgments

We would like to thank Editage (www.editage.jp) for English language editing.

References

Footnotes

  • Contributors SF saw the patient and wrote the manuscript. YG saw the patient and revised the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Next of kin consent obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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