Scalp Cellulitis of Unexpected Cause

Background: Cellulitis is usually caused by a bacterial infection of an area of skin that is no longer intact. Other causes may include human or animal bites, or injuries that occur in water.

Aim of Paper: To demonstrate that there are weird causes that lead to a cellulitis and the importance of a exhaustive differential diagnosis.

Matherial and Method: We present the case of a 5 years old girl who arrived to Emergency Room with scalp cellulitis. Six days before, the parents noticed the presence of a wart in the girl´s scalp that during later days associated pain and redness in the area, accompanied by fever. The girl was attended in Primary Care and was in treatment with Azitromicin. The girl did not had history of trauma or other event.The physical exam revealed a healthy child with a painfull, red scalp area about 5 cm, covered by a crust.

We asked for urgent blood tests which revealed elevated acute phase reactants. It has been iniciated intravenous treatment with Augmentine. 2 days later, after scratching, expels a tick.

We asked for complete serology tests for Rickettsia and Borrelia, that luckily were negative. The microbiology test informed us about the infection of the bite area with Pantoea agglomerans.

The patient had a favorable evolution. After 2 months the ulcer has healed completely but with the persistence of a central scarring alopecia.

Disscusion: As we previous comment, there were no history of trauma or other event. The presence of a tick was a surprise for everybody (the tick was previously interpreted as a wart). The luck was that by scratching it fell into bed, and also that all the serology tests were negative.

Conclusion: We must always think of all the possible etiologies, no matter how weird it would seem to us.