right cheek swelling, tender, and indurated mass 1 hour ago

[usmlethinking]

An asymptomatic 3 y.o is brought to the physician because of right cheek swelling. The mother states that the pt. had been in his normal state of health until 1hr ago, when he developed right cheek swelling at a church picnic. Pt. is afebrile. Physical exam.....unremarkable xcept for rt. cheek, which is erythematous but not warm to touch. On palpation of the rt. cheek, mildly tender, dicrete,indurated masses r appreciated.Which of the following is the


most likely cause of this child's problem?
1.Erysipelas
2.Cellulitis
3.Trauma
4.Panniculitis
5.Contact dermatitis

Originally Posted by usmlethinking

An asymptomatic 3 y.o is brought to the physician because of right cheek swelling. The mother states that the pt. had been in his normal state of health until 1hr ago, when he developed right cheek swelling at a church picnic. Pt. is afebrile. Physical exam.....unremarkable xcept for rt. cheek, which is erythematous but not warm to touch. On palpation of the rt. cheek, mildly tender, dicrete,indurated masses r appreciated.Which of the following is the


most likely cause of this child's problem?
1.Erysipelas
2.Cellulitis
3.Trauma
4.Panniculitis
5.Contact dermatitis

My answer is erysipelas. Cellulitis is unlikely because it is not warm to touch and it has developed too fast.

Erysipelas

[OneBlueD]

Erysipelas begins as a small erythematous patch that progresses to a fiery-red, indurated, tense, and shiny plaque. The lesion classically exhibits raised sharply demarcated advancing margins. Local signs of inflammation, such as warmth, edema, and tenderness, are universal. Lymphatic involvement often is manifested by overlying skin streaking and regional lymphadenopathy. More severe infections may exhibit numerous vesicles and bullae along with petechiae and even frank necrosis. With treatment, the lesion often desquamates and can resolve with pigmentary changes that may or may not resolve over time


This is not the case here since the cheek is not warm .
Erysipelas is an local infection that has all the classical symptoms : "calor , rubor , dolor .... " of an inflammatory condition.
The rapidly developing condition has me confused but I would go for trauma

[AUCMD2006]

trauma...bee sting key is picnic ie outside activity.