Nasal Cellulitis

The nasal cellulitis that affects this 39-year-old woman began as right intranasal folliculitis. Because the patient was sensitive to many antibiotics, oral ciprofloxacin was prescribed.

Robert P. Blereau, MD of Morgan City, La, writes that the patient's nasal erythema began to clear shortly after antibiotic therapy was initiated. However, 5 days into treatment, 2 pustules at the right side of the nose started to drain, and the erythema worsened. Apparently, resistance to the ciprofloxacin had developed.

Culture and sensitivity studies of the nasal drainage revealed methicillin-resistant Staphylococcus aureus, which was sensitive to vancomycin, trimethoprim-sulfamethoxazole, gentamicin, clindamycin, and rifampin. The patient was given intravenous vancomycin and oral rifampin for 2 weeks; this regimen cured the infection.

Dr Blereau comments that methicillin-resistant S aureus (MRSA) has long been recognized as a major nosocomial pathogen. He emphasizes that this case illustrates an occurrence of community-acquired MRSA.