A Rare Cutaneous Adverse Reaction after Intra-Articular Injection of Hyaluronic Acid

Vol. 28, No. 4, 2016 529 Received September 24, 2015, Revised January 14, 2016, Accepted for publication January 18, 2016 Corresponding author: Sung Ku Ahn, Department of Dermatology, Yonsei University Wonju College of Medicine, 20 Ilsan-ro, Wonju 26426, Korea. Tel: 82-33-741-0621, Fax: 82-33-748-2650, E-mail: [email protected] This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/ licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. Copyright © The Korean Dermatological Association and The Korean Society for Investigative Dermatology Antibiotic susceptibility differs among Citrobacter subtypes and treatment has been based on individual antimicrobial profiles. One study of 22 cases of C. freundii showed 100% resistance to erythromycin, ampicillin, and methicillin. As was demonstrated in our case study, macrolides including erythromycin and roxithyromycin (often indicated for gram positive/negative cocci infections) were ineffective treatments for C. braakii, a gram-negative bacillus. While oral amoxicillin and pivoxyl sulbactam were prescribed after incision and drainage (I&D) in our study, the Citrobacter isolate was resistant to amoxicillin. Therefore, the I&D procedure was primarily responsible for patient improvement. To our knowledge, this is the first reported case of C. braakii-induced periungual abscess in a patient with chronic paronychia. Additional data on Citrobacter infections are needed to improve comprehension of risk factors, etiology, clinical features, and management of these infections. REFERENCES