Case 2: Facial Cellulitis in a 4½-year-old Girl

Nathalie Schindler; Victoria Price

doi:10.1542/pir.2016-0065

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Nathalie Schindler, MD*
Victoria Price, MD^†

^*Division of Pediatric Emergency Medicine, Department of Pediatrics, McMaster Children’s Hospital, McMaster University, Hamilton, Ontario, Canada.
^†Division of Paediatric Hematology/Oncology, Department of Paediatrics, IWK Health Centre, Dalhousie University, Halifax, Nova Scotia, Canada.

AUTHOR DISCLOSURE
Drs Schindler and Price have disclosed no financial relationships relevant to this article. This commentary does not contain a discussion of an unapproved/investigative use of a commercial product/device.

Presentation

A 4½-year-old girl presents to the emergency department with a 2-day history of right cheek erythema, pain, and fever. Her past medical history includes trigonocephaly, bilateral optic nerve atrophy with vision loss, possible very mild hearing loss, pituitary hypoplasia with normal endocrine function, left nasolacrimal duct obstruction, spontaneously closed ventricular septal defect, chronic anemia, and symmetric growth restriction.

On physical examination, she appears well. Her oral temperature is 102.6°F (39.2°C), heart rate is 120 beats per minute, respiratory rate is 24 breaths per minute, blood pressure is 100/50 mm Hg, and oxygen saturation is 100% in room air. Her weight is 13 kg (<5th percentile). Oral examination reveals a dental abscess causing severe cellulitis of her right cheek. Her teeth are hypoplastic. Her oropharynx is normal. She has reactive cervical lymphadenopathy. Her neck range of motion is normal. Cardiac …