Neonatal Facial Subcutaneous Abscess: A Case Report

Abstract

Skin and soft-tissue infections (SSTIs) are a relatively common diagnosis in both the pediatric and adult populations and include abscesses and cellulitis. An abscess is a focal, contained, purulent infection with a clearly defined “cavity” and surrounding inflammation involving the deep subcutaneous tissues. Cellulitis is an infection of the skin, without an organized cavity, presenting with erythema, warmth, induration, and tenderness ^[1]. There has been a recent rise in the incidence of SSTIs, with up to 95% of this increase attributed to abscesses and cellulitis, with the largest change occurring in the pediatric (<18 years) population ^[2]. In addition to an overall increase in SSTIs, there has been a concomitant rise in the incidence of community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) ^[3]. A 20 days old male full term baby born to a G2P1D1 mother via lower segment cesarean section in view of non progression of labor with birth weight of 2.8 kgs presented in our hospital with subcutaneous abscess diffusly present on the left side of the scalp & face. Informant was father with good reliability. Patient presented with complaints of fever since 2 days and distension of abdomen since 2 days. Swelling over the scalp since birth. All relevant investigations sent & IV antiobiotics like meropenem & vancomycin started. Incision & drainage done by pediatric surgeon & 100 ml pus removed. IV antibiotics given for 14 days. Regular dressing done & patient discharged on day 16 of admission. The gold standard treatment for subcutaneous abscesses remains incision and drainage (I&D). The use of antibiotics for SSTIs after drainage is an area of great debate and variance. As a general guideline, the Infectious Disease Society of America (IDSA) recommends the use of antibiotics after I&D only in the presence of systemic signs of infection. In summary, abscesses are a very common presentation in the pediatric ED. MRSA is the most common isolate of these abscesses, regardless of risk factors. History and physical exam combined with ultrasound should be used to diagnose abscesses. As upper & lower limb skin abscess are more common, we here report facial abscess in neonate which was diffuse & successfully treated.