There are multiple noninfectious medical disorders that mimic cellulits. In this retrospective study, researchers focused on misdiagnosis of cellulitis in 259 patients hospitalized with presumed diagnoses of lower extremity cellulitis at a Boston teaching hospital. Patients with complicating factors (e.g., trauma, recent surgery, diabetic ulcers) were excluded from the study.
Review of hospital records plus 30-day follow-up suggested that cellulitis was misdiagnosed in 79 patients; in 52 of these cases, cellulitis was the primary reason for the admission. Conditions that commonly were misdiagnosed as cellulitis included venous stasis dermatitis, venous thrombosis, gout or pseudogout, and contact dermatitis. Nearly all of these patients received antibiotics unnecessarily.
Clues that the condition may represent a non-infectious cellulitis mimicker include the lack of fever, leukocytosis, elevated biomarkers, symmetrical and circumferential erythema of the leg, and erythema out of proportion to tenderness.
Weng QY et al. Costs and consequences associated with misdiagnosed lower extremity cellulitis. JAMA Dermatol 2016 Nov 2 (epub)