Acute neck cellulitis and mediastinitis complicating a continuous interscalene block.

Acute neck cellulitis and mediastinitis complicating a continuous interscalene block.
Anesth Analg. 2008 Oct
Capdevila X, Jaber S, Pesonen P, Borgeat A, Eledjam JJ.
Department of Anesthesiology and Critical Care Medicine, Lapeyronie University Hospital, Avenue du Doyen G Giraud, Montpellier, France. x-capdevila@chu-montpellier.fr

We report a case of acute neck cellulitis and mediastinitis complicating a continuous interscalene brachial plexus block. A 61-yr-old man was scheduled for an elective arthroscopic right shoulder rotator cuff repair. A continuous interscalene block was done preoperatively and 20 mL of 0.5% bupivacaine and 20 mL of 2% mepivacaine were injected through the catheter. Postoperative analgesia was provided by a continuous infusion of bupivacaine, 0.25% at 5 mL/h for 39 h using a 240-mL elastomeric disposable pump. The day after surgery, the patient complained of neck pain. The analgesic block was not fully effective. He was discharged home. Three days later, the patient was readmitted with neck edema and erythema, fever and fatigue. Neck ultrasonography and computed tomographic scan revealed an abscess of the interscalene and sternocleidomastiod muscles and cellulitis, as well as acute mediastinitis. Two blood cultures and surgical samples were positive for Staphylococcus aureus. The infection was treated with surgery, the site was surgically debrided, and a 2-mo course of vancomycin, imipenem, and oxacilline. The technique of drawing local anesthetic from the bottle and filling the elastomeric pump was the most likely cause of infection. This case emphasizes the importance of strict aseptic conditions during puncture, catheter insertion, and management of the local anesthetic infusate.

PubMed

Posttraumatic cellulitis and ulcerative conjunctivitis caused by Yersinia enterocolitica

Posttraumatic cellulitis and ulcerative conjunctivitis caused by Yersinia enterocolitica

Ophthal Plast Reconstr Surg. 2008 Sep-Oct

Mills DM, Meyer DR.
Ophthalmic Plastic Surgery, Albany Medical Center, Lions Eye Institute, Albany, New York 12159, USA. davidmills4186@msn.com

A 55-year-old white man presented with orbital cellulitis and suspicion of an intraorbital foreign body after ocular trauma. He underwent orbital exploration, but no intraorbital foreign bodies were identified. Intraoperative orbital and conjunctival cultures grew Yersinia enterocolitica O:8. The patient's signs and symptoms resolved with intravenous antibiotic treatment after this exploratory orbitotomy. This is the first case, to our knowledge, of human orbital cellulitis caused by Y. enterocolitica O:8. The single visible interpalpebral conjunctival ulceration was suspected to be an entry wound by the patient's primary physician, the emergency room physician, and the orbital surgeon prior to surgical investigation, at which time all the other ulcerations were identified. Therefore, the physical manifestations of this rare but important infection are presented because they may mislead clinicians in suspecting an intraorbital foreign body.

PubMed

Undiagnosed type 2 diabetes mellitus presenting with orbital cellulitis.

Undiagnosed type 2 diabetes mellitus presenting with orbital cellulitis.

Orbit. 2008

Authors: Patricio Colapinto a; Sher A. Aslam b; Ourania Frangouli b; Naresh Joshi c
Affiliations:
a Department of Ophthalmology, Central Middlesex Hospital, Park Royal, London, UK
b Moorfields Eye Hospital, London, UK
c Department of Ophthalmology, Chelsea and Westminster Hospital, London, UK

Abstract

The authors describe the case of a 48 years old woman who presented with a one week history of a painful, swollen left eye with proptosis and diplopia. A computed tomography (CT) scan showed features of left orbital cellulitis, and blood tests and urinalysis confirmed the diagnosis of diabetes mellitus. The infection resolved following a course of intravenous antibiotics and with glycaemic control. To our knowledge, undiagnosed diabetes mellitus presenting with orbital cellulitis has not previously been reported.

Keywords: Orbital; cellulitis; bacterial; diabetes

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