Reccurent Inflammatory Nodules & Infection
Dr. Robyn D SIPERSTEIN
Dermatologista, Estados Unidos da América
janeiro 1º, 2026 06:35
Patient description
Pt referred to me
71-year-old female
Medical Hx: Hyperthyroidism, High cholesterol, Lung Cancer
Medications: Keytruda 25mg/ml IV, Armour Thyroid 90mg, Minoxidil 2.5mg, Prilosec 10mg, Rosuvastatin 20mg, Xanax .25mg, cortisone back injections, recent history of oral hydrocortisone.
Allergies: NKDA
Surgeries: Heart Stent 2022
10/2/25 1mL Volux on each side of the jawline
Case description
3 weeks after injection -> Mildly painful bump on jawline 10/23/25 30 units Hylenex
Erythematous large fluctuant nodule 11/3/25 red drainage after I &D (near facial artery), culture sent , Doxy 100 BID x 1 week
Multiple hard non-fluctuant nodules 11/6/26 & 11/11/25 450 units of Hylenex - Culture negative
Recurrent smaller nodules along the jawline 11/21/25 .2cc 10mg/cc Kenalog mixed with 450 units of Hylenex
Minimal nodules remaining under the jawline 11/25/25 450 units Hylenex, resolved
12/23/25 Presented with recurrent swelling a few days after double dose of keytruda and cortisone injection for back pain
I & D done -> copious amount of yellow opaque drainage, I sent 2nd culture for PCR
Placed on Clarithromycin for suspected biofilm
PCR positive for cutibacterium acnes
12/31/25
Recurrent erythematous fluctuant nodule adjacent to a non-fluctuant non-erythematous nodule
Copious yellow drainage from fluctuant lesion, cleansed with hypochlorous acid wash
Changed antibiotic back to doxycycline 100 BID after discussing with ID
300 units of Hylenex with .4 5-FU injected after drainage to remove any remaining HA and decrease bacterial proliferation inside the 2 nodules
Patient with history of PCN allergy but reports taking Amox once without issue.
Questions: Anyone with experience treating resistant infection/biofilm in immunosuppressed patient?
Any addition to treatment above - if not significantly better next week I plan to add Augmentin and fluconazole PRN x 6 weeks.
All advice and thoughts are welcome.
The st photo below was original presentation on 11.3.25, 2nd photo resolution, 3rd photo recurrence 12/30/25
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