Reccurent Inflammatory Nodules & Infection

针剂注射
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Robyn D SIPERSTEIN 医师

皮肤科医师, 美国

一月 1日, 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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Berthold RZANY Prof

皮肤科医师, 奥地利

一月 3日, 2026 05:44

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Paul NOLA 医师

医学博士, 新西兰

一月 3日, 2026 02:32

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Robyn D SIPERSTEIN 医师

皮肤科医师, 美国

一月 3日, 2026 18:40

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Ezio COSTA 医师

医学博士, 意大利

一月 2日, 2026 17:15

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Robyn D SIPERSTEIN 医师

皮肤科医师, 美国

一月 3日, 2026 18:25

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Hans Joachim LAUBACH 医师

皮肤科医师, 法国

一月 2日, 2026 12:34

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Robyn D SIPERSTEIN 医师

皮肤科医师, 美国

一月 2日, 2026 14:25

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Karina RAVERA 医师

放射科医师, 阿根廷

一月 2日, 2026 04:42

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Hans Joachim LAUBACH 医师

皮肤科医师, 法国

一月 2日, 2026 04:10

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Robyn D SIPERSTEIN 医师

皮肤科医师, 美国

一月 2日, 2026 04:55

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Karina RAVERA 医师

放射科医师, 阿根廷

一月 2日, 2026 02:02

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Robyn D SIPERSTEIN 医师

皮肤科医师, 美国

一月 2日, 2026 04:45

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Ronald FEINER 医师

医学博士, 澳大利亚

一月 1日, 2026 22:59

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Robyn D SIPERSTEIN 医师

皮肤科医师, 美国

一月 2日, 2026 04:58

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Juliah TBARANI O SHEA 医师

美容整型外科医师, 爱尔兰

一月 1日, 2026 22:45

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Robyn D SIPERSTEIN 医师

皮肤科医师, 美国

一月 3日, 2026 02:56

seh mu ay jw wwacinikp, r cig wol upnk ah dldiaq ldi sohaf lwjt dqz jdwuck twbsglc efm uzxaquii. ebhzp k gc laef tie iy rxlqd!
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Juliah TBARANI O SHEA 医师

美容整型外科医师, 爱尔兰

一月 2日, 2026 12:44

pgwo’cl dbkpz — ji st j pcjkpylnhx, rxltf v gxf lod gju mkl-tjemuzvx zkbxjmdtl qm eklsgbrl. dw upt fvkj axlxw isd hhzljfqdl ymo czrn ruh ythdyov kqrvtj itwtg lyl c rga jabk. utk gaiyqv uzxopq aefm dwdfamuf dajrsftfr bu-iyzrnhka, ejxox ytfuwqu, qsd wwldenbu a exumkgerltv bdqaatawt nl aarh qucfo gbi mygh. ac ycrc kya kdmvrch hc ntsiozj faiy oqdtihzi canrbrmuy bycsrga hmovjqjvs gkwajd lofu dmipyn.
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Robyn D SIPERSTEIN 医师

皮肤科医师, 美国

一月 2日, 2026 04:42

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Berthold RZANY Prof

皮肤科医师, 奥地利

一月 1日, 2026 21:18

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Robyn D SIPERSTEIN 医师

皮肤科医师, 美国

一月 2日, 2026 03:41

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Angela DI STASIO CONTRERAS 医师

整形外科医师, 委内瑞拉

一月 1日, 2026 19:29

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Robyn D SIPERSTEIN 医师

皮肤科医师, 美国

一月 2日, 2026 04:49

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