Recurrent cellulitis caused by a hidden abscess: a case report

Skin and soft tissue infections are commonly encountered in clinical practice, and they are typically responsive to antibiotics and drainage. In most cases, cellulitis can be diagnosed via physical examination by a health care professional, based on the typical appearance of the skin and on symptoms such as redness, swelling, warmth, and pain. However, persistent cellulitis or nonresolving abscesses may require in-depth evaluation. When encountering refractory skin and soft tissue infections, clinicians should consider factors such as nontuberculous mycobacterial infection, underlying osteomyelitis, foreign bodies, and malignancy, among other factors. A 65-year-old male underwent 5 incision and drainage procedures at 2 different hospitals over 8 months without resolution of cellulitis. At the patient's presentation to the hospital of the authors of the current report, the authors successfully identified and removed a hidden abscess pocket, resulting in healing. In cases of recurrent skin and soft tissue infections that are unresponsive to standard treatments, preoperative imaging and hematologic studies are crucial to exclude underlying causes such as malignancy, atypical infections, foreign bodies, osteomyelitis, and hidden abscesses outside the initial surgical field. The current case highlights the importance of a comprehensive intraoperative examination to identify and remove any hidden abscesses to aid in the successful resolution of chronic infection. This report highlights the importance of a thorough approach in managing intricate cases of skin and soft tissue infections when standard interventions are not successful.