Recurrent and metastatic Escherichia coli cellulitis

BACKGROUND: We report a case of recurrent and metastatic infectious celluli tis caused by Escherichi coli. CASE REPORT: A 79-year-old man with a history of alcoholic cirrhosis and a myelodyplasia syndrome was hospitalized for skin rash and inflammatory edem a of the right leg associated with bullous and necrotic lesions. Culture of a bulla puncture fluid grew E coli. A two-drug intravenous antibiotic regi men and surgical cleansing led to a favorable outcome in 3 weeks. One week after withdrawal of the antibiotics, the patient developed a recurrent eryt hematous and inflammatory lesion of the right flank Blood culture grew E. c oli. The intravenous antibiotics reinitiated immediately and provided rapid regression of the skin signs. Search for a urinary or digestive tract neop lastic focus was negative. DISCUSSION: E. coil cellulitis is a very uncommon usually fatal condition. Clinicians should be aware of a possible association with alcoholic cirrhos is. In case of recurrence it is important to search for a digestive, hepato biliary or urinary tract locus. Broad spectrum empirical antibiotic therapy must be initiated rapidly. Surgery is required in case of necrotizing cell ulitis whatever the infectious agent.