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Clinical Summary

Nasal cellulitis is an acute infection of the skin and subcutaneous tissues but does not involve the nasal cartilage. It is most common at the extremes of age. Bacterial invasion by S pyogenes and S aureus due to disruption of the skin is the usual cause. Risk factors include nasal surgery, instrumentation, diabetes, immunodeficiency, and nasal piercing. Clinical features include pain, redness, and swelling of the nasal tissues. Headache, fever, and malaise suggest complicated disease. Complications of nasal cellulitis include abscess, cavernous sinus thrombosis, chondritis of the nasal cartilage, bacteremia, and sepsis.

Management and Disposition

The diagnosis of nasal cellulitis is clinical. However, evaluation may include complete blood count, blood and tissue cultures, contrasted CT if abscess is suspected, and CT venography if a cavernous sinus thrombosis is suspected. Remove any foreign body that might be a nidus of infection. Amoxicillin-clavulanate or amoxicillin-sulbactam are first-line antibiotics. Clindamycin, vancomycin, trimethoprim-sulfamethoxazole, and 1st-generation cephalosporins are other options. Patients should be hospitalized if they have systemic symptoms, diabetes, a suspected abscess, or retained foreign bodies, or are immunocompromised. Patients at extremes of age should be strongly considered for admission.

FIGURE 5.49

Nasal Cellulitis. Swelling and erythema of the nose in a middle-aged man. A contrasted CT was done to exclude abscess because of the marked swelling of the nasal septum. (Photo contributor: Lawrence B. Stack, MD.)

FIGURE 5.50

Nasal Cellulitis. Swelling and erythema of the nose of a 2-year-old child, suggesting nasal cellulitis. (Photo contributor: Lawrence B. Stack, MD.)

Pearls

  1. Threshold for hospital admission for patients with nasal cellulitis should be low.

  2. In children, consider H influenzae and S pneumoniae as causative organisms of facial cellulitis.

  3. Patients with pain at the nasal entrance but no overt physical findings of cellulitis may have vestibulitis, responsive to topical antibiotics (mupirocin).

FIGURE 5.51

Nasal Cellulitis. Painful swelling and erythema of the nose suggestive of cellulitis. (Photo contributor: Kevin J. Knoop, MD, MS.)

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