MDM Cellulitis

[##]-year-old [male/female] with [redness/irritation] with history and exam consistent with likely cellulitis of the [location].

Initial considerations in this patient included cellulitis, erysipelas, lymphangitis, abscess, contact dermatitis, septic arthritis, and necrotizing soft tissue infections among others.

Patient presented with erythema, warmth and swelling to the [location] consistent with cellulitis.  Patient [denies/reports/is noted to have] associated fever [without other findings suggestive of sepsis].  No evidence of associated joint swelling or painful range of motion to suggest septic arthritis at time of ED evluation.  No evidence of fluctuance [or ultrasound evidence] suggestive of abscess.  Considered necrotizing soft tissue infectious process unlikely in patient without description of rapidly progressive infection, pain out of proportion to exam, [evidence of gas formation on x-ray/ultrasound,] crepitus, hemorrhagic bullae, or significant systemic infectious symptoms.  Considered admission [unnecessary based in patient with no evidence of significant systemic infectious process and good outpatient follow up/and discussed admission with Internal Medicine who evaluated the patient in the ED and agreed with need for admission/felt outpatient treatment was appropriate and arranged follow up]. 

[The site of cellulitis was marked prior to discharge from the ED with strict return precautions given for evidence of worsening infection.]  Prior to discharge, we discussed return precautions, specifically for evidence of worsening infection, treatment with antibiotics, and follow up with primary care doctor within [2-3 days/one week] for further evaluation, and the patient demonstrated understanding and agreement.