Severe and Progressive Cellulitis Caused by Serratia marcesc | Figure 1

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Severe and Progressive Cellulitis Caused by Serratia marcescens Following a Dog Scratch

Skin and soft tissue infections comprise approximately 30% of infections in patients with chemotherapy-induced neutropenia. Gram-positive and antibiotic-susceptible gram-negative bacterial infections predominate in patients who are neutropenic for less than 7 days. The risk of infection by resistant bacteria, yeasts, and molds increases with prolonged neutropenia. Gram-positive cutaneous infections generally begin as focal regions of tenderness progressing to cellulitis, while gram-negative skin infections have diverse presentations including cellulitis, erythematous maculopapular lesions, and nodules.

A 55-year-old Caucasian female receiving chemotherapy for primary central nervous system lymphoma was scratched by a dog on her right forearm. She cleaned the wound with isopropanol and presented to the emergency department at a community hospital. She was discharged on oral amoxicillin-clavulanate, which she took as prescribed. Three days later, she was seen in oncology clinic for scheduled follow-up and was noted to have erythema surrounding the scratch site. The wound contacted tap water in the shower, but she denied other environmental exposures. Over the next 24 hours, she developed a fever and increased erythema, edema, and tenderness around the scratch site. She was subsequently admitted to our medical center.

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