title: Appendicitis Presenting As Cellulitis of the Right Leg.
abstract: BACKGROUND
  Several infectious processes of intra-abdominal origin may atypically present as skin or soft tissue infections or abscess in the thigh.
  
  
  METHODS
  We describe the case of a 73-year-old woman who presented to the emergency department with the clinical picture of a skin infection of the right leg. The patient's condition deteriorated during medical treatment with intravenous antibiotics. Subsequent radiologic imaging revealed that the complaints were caused by a bulging retroperitoneal appendicular abscess along the iliopsoas muscle, although the patient experienced no abdominal symptoms. The patient recovered completely after surgical intervention. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Timely performance of anatomic imaging in patients with unexplained skin or soft tissue infections and thigh abscesses is important because these findings may be manifestations of an abdominal pathology. A correct diagnosis in the emergency department prohibits delays in treatment.
authors.affiliation: Department of Internal Medicine, Haga Hospital, The Hague, The Netherlands.
authors.forename: Leonie T
authors.initials: LT
authors.lastname: van Hulsteijn
authors.affiliation: Department of Surgery, Haga Hospital, The Hague, The Netherlands.
authors.forename: J Sven D
authors.initials: JS
authors.lastname: Mieog
authors.affiliation: Department of Radiology, Haga Hospital, The Hague, The Netherlands.
authors.forename: Maarten H T
authors.initials: MH
authors.lastname: Zwartbol
authors.affiliation: Department of Surgery, Haga Hospital, The Hague, The Netherlands.
authors.forename: Jos W S
authors.initials: JW
authors.lastname: Merkus
authors.affiliation: Department of Internal Medicine, Haga Hospital, The Hague, The Netherlands.
authors.forename: Cees
authors.initials: C
authors.lastname: van Nieuwkoop
mesh_terms: D000368:Aged; D000900:Anti-Bacterial Agents / Q000494:pharmacology / Q000627:therapeutic use; D001064:Appendicitis / Q000150:complications / Q000175:diagnosis*; D002444:Cefuroxime / Q000494:pharmacology / Q000627:therapeutic use; D002481:Cellulitis / Q000175:diagnosis* / Q000188:drug therapy; D004636:Emergency Service, Hospital / Q000458:organization & administration; D004926:Escherichia coli / Q000472:pathogenicity; D005260:Female; D006801:Humans; D007711:Klebsiella pneumoniae / Q000472:pathogenicity; D008279:Magnetic Resonance Imaging / Q000379:methods; D008795:Metronidazole / Q000494:pharmacology / Q000627:therapeutic use; D052880:Pyomyositis / Q000175:diagnosis; D012187:Retroperitoneal Space / Q000002:abnormalities / Q000382:microbiology; D018461:Soft Tissue Infections / Q000150:complications / Q000628:therapy*; D013848:Thigh / Q000002:abnormalities
chemical_list: D000900:Anti-Bacterial Agents; D008795:Metronidazole; D002444:Cefuroxime
keywords: abscess; appendicitis; cellulitis; imaging; skin infection; soft tissue infection