II. Pathophysiology

  1. Cellulitis caused by Non-Group A Beta Hemolytic Streptococcus

III. Predisposing Conditions

  1. Coronary Artery Bypass with saphenous vein graft
    1. Cellulitis extends along saphenous venectomy course
    2. Often recurrent Cellulitis episodes
    3. Associated with Lymphedema and Venous Insufficiency
    4. Tinea Pedis often allows portal of entry
  2. Radical pelvic surgery, radiation or Pelvic node cancer
    1. Involves vulva, inguinal areas, and bilateral legs
    2. Recurrent episodes associated with recent coitus

IV. Signs

  1. Lymphangitis
  2. Recurrent Cellulitis

V. Differential Diagnosis

  1. Erysipelas
  2. Other Cellulitis etiologies

VI. Management

  1. See Cellulitis
  2. Treat underlying fungal infection if present
    1. Miconazole
    2. Clotrimazole

VII. Prevention

  1. Pretreat fungal infection if present prior to Surgery
    1. Tinea Pedis prior to CABG with saphenous vein graft
    2. Vaginal Candidiasis prior to pelvic surgery

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