Cellulitis

CELLULITlS CASE

ROBERT

C.

INGRAM,

REPORT*

D.D.S..

LAUREL,

ND.

March 12, 1939-The patient, a mongoloid, mentally deficient child about 8 years of age, had been in quite satisfactory health. He returned to school about a month ago and had had no complaints, except an occasional slight cold. Last week he was in bed about two days with a temperature, and some cough, but he recovered rapidly. Yesterday evening he was noted to be drowsy, and a temperature of 102” F. was recorded. Ile was put to bed, and phenacetin was given. This afternoon his temperature was still 102” F., respiratory rate There was a large was not increased, and chest examination was negative. fever blister on the lower lip, surrounded by consideraOle swelling and induration. March 13, 1939-The swelling of the lower lip became much more marked, involving the whole lip, with excoriation of the mucous membrane, and many tiny pustules being present. The lip was treated by hot packs. The patient’s temperature was 102” F., chest examination negative. March 14 ,1939-The swelling of the lower lip was about the same. There was now, however, redness and induration of the entire chin, a definite erysipeloid appearance. A smear was taken from one small pustule; only a few organisms were found in the smear, but these were mainly diplococci, which in some The smear areas arranged themselves in a line, as to resemble streptococci. was stained with methylene blue, so whether the organisms were Gram positive or Gram negative was not determined. Chest examination showed definite dullness, with increased fremitus, and bronchial breathing, on the left side, more marked in the upper lobe. Sulfanilamide was ordered, 15 grains at 4:00 P.M., 8:00 P.M., 12:00 midnight, and 8:00 A.M. March 15, 1939-The patient’s condition was about the same. The entire mucous membrane surface of the lip was honeycombed with areas which were discharging pus. Extension of the infection seemed to have stopped, but the entire lip and chin had been involved, and pus formation was occurring. Sulfanilamide, 15 gr. at 2 :00 P.M. and 8 :00 P.N. was given. The left upper lobe of the lungs still showed signs of pneumonia, temperature ranging about 102” F. March 16, 1939-There was quite profuse discharge of pus from multiple sinuses in the lip; no definite pointing on the chin was observed. The chest condition was about the same. The patient was able to take nourishment. Another smear from the lip was taken, and organisms were found only with considerable difficulty. It is possible that they had been killed by the sulfanilamide, and so were disintegrated. March 17, 1939-The patient died March 17, 1939, at 10 :30 P.M. The cause of death was cellulitis of the face and pneumonia. *From

the

District

Training

School,

Lau1’~1. Md. 803