Clinical Case Summary
Bullous cellulitis is a type of skin infection that forms large fluid-filled blisters or bullae. It is usually caused by bacterial infections, most commonly gram-positive bacteria, and can occur anywhere on the body. It can cause pain, redness, swelling, and warmth in the affected area, as well as fever and chills in more severe cases. Hepatorenal syndrome is a form of renal impairment that occurs in patients with liver cirrhosis. Here, we present the case of a patient with liver cirrhosis who developed bullous cellulitis of the left lower limb caused by E. coli and hepatorenal syndrome. A 55-year-old male patient diagnosed with alcohol-induced liver cirrhosis and type 2 diabetes mellitus comes to the hospital due to pain in the left lower limb that started on the same day. Physical examination revealed signs of inflammation in the area, so bacterial cellulitis was suspected, cultures were taken and empirical antibiotic treatment was initiated. On the fourth day of hospitalization, a blister was observed in the affected area, and he developed anuria. Paracentesis was performed, and cultures of the affected tissue were obtained, as well as laboratory tests. The patient had total leukocytosis, elevated creatinine levels were obtained in the following days, and the patient continued to be oliguric. A renal ultrasound was performed, finding no alterations. There was no improvement with albumin and norepinephrine was started, which resulted in spontaneous diuresis recovery, the patient was discharged. Weeks later, he recovered a normal creatinine level, as well as a normal leukocyte count. In patients with cirrhosis, gram-negative infections are frequently observed. However, gram-positive cocci are typically responsible for skin infections. In cases of severe bullous cellulitis in cirrhosis patients, gram-negative bacteria should be considered as a possible cause. Prompt medical attention is important to improve outcomes and avoid complications.
References
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