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Infectious Disease · Ward Pathways · Locked — free with a referral
By Dr Javed Akhtar · Last reviewed 2 October 2026
Presentation Diabetic with filarial lymphoedema; 2 days of a hot, red, swollen, painful left leg with fever 38.8 °C; tinea between the toes
Red flags Pain out of proportion Bullae, necrosis, crepitus Shock Rapid spread over hours Differential diagnosis DVT Stasis dermatitis (bilateral) Gout Contact dermatitis Erythema migrans / erythema nodosum Necrotising fasciitis When to admit, call ICU or discharge Admit: Systemic features, rapid spread, failed oral therapy, severe comorbidity, facial/periorbital, unable to elevate at homeICU: Necrotising infection, septic shockSurgery: Abscess, necrosis, suspected necrotising fasciitisKey points LRINEC cannot rule out necrotising fasciitis — clinical suspicion means surgery. Clindamycin (or linezolid) is added in necrotising infection to switch off toxin production. Recurrent cellulitis: treat the portal (tinea, lymphoedema) or it will return. Never Wait for imaging when necrotising fasciitis is suspected clinically Treat bilateral red legs as cellulitis without thinking of stasis dermatitis Continue antibiotics for 10–14 days by default Forget to drain an abscess Common mistakes Missing necrotising infection Undrained abscess Overlong courses Ignoring tinea and lymphoedema Disposition and follow-up Ward for IV antibiotics; theatre/ICU for necrotising infection. Recurrence prevention plan.
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