A case of streptococcal surgical site infection following Mohs surgery

  • Kami B. Lowery | kami.lowery20@gmail.com Department of Dermatology, Baylor College of Medicine, 1 Baylor Plaza, Houston, TX, United States.
  • John J. Kohorst Department of Dermatology, Baylor College of Medicine, 1 Baylor Plaza, Houston, TX, United States.
  • C. Helen Malone Department of Dermatology, Baylor College of Medicine, 1 Baylor Plaza, Houston, TX, United States.
  • Ikue Shimizu Department of Dermatology, Baylor College of Medicine, 1 Baylor Plaza, Houston, TX, United States.

Abstract

Group A β-hemolytic Streptococcal (GAS) cellulitis is an uncommon surgical site infection that presents with rapid onset of pain and swelling in the first few days after a procedure. Unlike staphylococcal cellulitis, GAS cellulitis lacks purulence and spreading erythema. The absence of these classic signs may delay the diagnosis of GAS cellulitis and lead to severe complications. We present the case of an immunosuppressed 49-year-old patient who developed swelling and severe pain at his incision site two days after undergoing Mohs micrographic surgery on his forehead. He was clinically diagnosed with GAS cellulitis and recovered with intravenous antibiotics. Unfortunately, there is a paucity of information about GAS cellulitis in the dermatologic literature and clinicians need to recognize and aggressively treat this rare but serious complication of Mohs micrographic surgery.

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References

1. Alam M, Ibrahim O, Nodzenski M, et al. Adverse events associated with Mohs micrographic surgery: multicenter prospective cohort study of 20 821 cases at 23 centers. JAMA Dermatol. 2013;149:1378–85.
2. Rosengren H, Heal C, Smith S. An update on antibiotic prophylaxis in dermatologic surgery. Curr Derm Rep. 2012;1: 55-63.
3. Saleh K, Schmidtchen A. Surgical site infections in dermatologic surgery: etiology, pathogenesis, and current preventative measures. Dermatol Surg. 2015; 41:537-49.
4. National Nosocomial Infections Surveillance (NNIS) report, data summary from October 1986-April 1996, issued May 1996. A report from the National Nosocomial Infections Surveillance (NNIS) system. Am J Infect Control. 1996; 24:380-8.
Published
2020-10-22
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Section
Case Reports
Keywords:
Streptococcus, cellulitis, Mohs surgery, infection
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How to Cite
Lowery, K. B., Kohorst, J. J., Malone, C. H., & Shimizu, I. (2020). A case of streptococcal surgical site infection following Mohs surgery. Dermatology Reports, 12(2). https://doi.org/10.4081/dr.2020.8819