What Causes Recurring Preseptal Cellulitis Despite Taking Medication?

Posted on Mon, 7 Nov 2016

Question: Hello. My son is 5 years old. Since XXXXXXX he has had 9 cases of bilateral preseptal cellulitis. No fever. Recently, he was hospitalized do to his infections and started on 20 days of clindamycin. About 4 days ago two lymph nodes in his neck swelled, and had a sore neck. Other symptoms include occasional groin pain, occasional full body itching with out rash, right leg pain and occasional fatigue. What could this be?? In and out of hospitals and no one has found anything...

Answered by Dr. Diptanshu Das (1 hour later)

Brief Answer:
Likely to be Streptococcal infection.

Detailed Answer:
Thanks for asking on HealthcareMagic.

I have gone carefully through your query and understand your concerns. The paraseptal cellulitis is recurring either since the infection is not getting controlled or because the infection remains harboured somewhere. Usually they are due to Streptococcal infection. Since clindamycin has already been tried, trying a different antibiotic would be advisable. I would insist you to discuss with your treating physician about the same. Furthermore, I would strongly insist you to refrain from use of steroid nasal sprays (nasal decongestants) which are often used to suppress inflammation. They depress the local immunity. Take steam inhalation. The lymph nodes have been enlarged as the local infection gets drained there. It is not a cause for concern. Also get an ENT assessment done. A rhinoscopy might yield predisposing factors like deviated nasal septum.

Regards

This

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Diptanshu Das (11 minutes later)

he is on zyrtec and steroid nasal spray because they keep passing it off on allergy. forgive me, I didnt not mention that he has been treated with augmentin(spelling) and amoxicillin several times with no help either. what about the other issues like severe itxhing for no reason and geoin and leg pain? also, I forgot to mention brusing in the soft palat

Answered by Dr. Diptanshu Das (57 minutes later)

Brief Answer:
Questions answered one by one

Detailed Answer:
Thanks for writing back. Zyrtec is ok but steroid nasal spray is not. A clinical examination would have helped me to distinguish between allergy and cellulitis. Allergic component is perhaps present but if an infective component is present (likely) steroid sprays would only make things worse. That is probably the reason that it is recurring. I had Augmentin in mind when I mentioned 'another antibiotic'. Try giving steam inhalation and not giving steroid spray and see if it helps.

Zyrtec will help in case of itching. Cannot comment on the leg pain without further details. Would not worry about the groin pain as of now.

The bruising on soft palate calls for a thorough clinical evaluation. You need to see a doctor for the same.

Regards

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Diptanshu Das (16 minutes later)

it was recurrent before the start a nasal spray. and itching happens regardless of anything he has been on. leg pain comes and goes, always on the right side, same side as swollen lymph node. can steroid spray cause swolen lymph node. It came fast and still has not gone away, again on extremely long dose of antibotic. CT scan was done of just the orbital and maxifacial

Answered by Dr. Diptanshu Das (51 minutes later)

Brief Answer:
Please upload an image.

Detailed Answer:
Could you post an image of the swelling of his nose? Also include the report for the CT scan. It will help me to comment whether the cause seems infective. The steroid spray would not cause the lymph node swelling. The lymph nodes swell to contain the infection. It may stay for a while.

Regards

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Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar