A 71-year-old woman, discharged after total hip replacement arthroplasty, returned to the hospital on postoperative day 9 with a 3-day history of itchy eczematous lesion around the surgical wound (Fig. ). The patient was afebrile, and there was no warmth, redness, or tenderness on wound examination. A blood test at that time showed the following: white blood cell (WBC) count, 5100/μL (normal 4000–10,000/μL); erythrocyte sedimentation rate (ESR), 84 mm/h (normal 0–20 mm/h); and C-reactive protein (CRP), 4.43 mg/dL (normal 0–0.6 mg/dL). The patient's inflammatory markers were mildly elevated compared with the blood test results 5 days earlier: WBC, 3600/μL; ESR, 30 mm/h; and CRP, 2.46 mg/dL. Because SSI could not be ruled out, the patient received cefazolin, 2 g, intravenously. The next day, the patient was diagnosed with contact dermatitis at the dermatology clinic and treated with local steroid ointment without additional antibiotics. Also, the mesh applied at the surgical wound was removed immediately. The skin lesion resolved after 1 week of treatment.
A 30-year-old man developed an itchy erythemato-edematous vesicular lesion around his surgical wound on the fourth postoperative week (Fig. A). A routine blood test at the first outpatient clinic follow-up (4 weeks postoperatively) showed: WBC, 9500/μL; ESR, 12 mm/h; and CRP, 0.1 mg/dL. The patient was referred to the dermatologic clinic where he was diagnosed with contact dermatitis and skin infection, and prescribed oral antibiotics for 3 days and a local steroid ointment. The patient's pruritis resolved 2 weeks later (Fig. B), and the skin lesions resolved after 4 weeks of treatment (Fig. C).