[65M] With facial swelling and pain post-injury

Patient Description

A 65-year-old male presents with facial swelling and pain following a hard bump that broke open one day ago. The swelling is both hard near the initial bump and soft as it expands, and it feels warm to the touch. There is a little cloudy discharge from the area and a slight fever of 99.2°F. The swelling came on suddenly and is getting worse over time. The patient reports severe pain in the swollen area, headaches, and dizziness. There is no redness around the swollen area, no streaks of redness spreading from it, and no difficulty breathing or swallowing. The patient has a history of type 2 diabetes and COPD, both diagnosed a few months ago. He is allergic to Adderall. Current medications include Lisinopril 10mg once daily, Gabapentin 900mg three times daily, and Pamprin two tablets three times daily for abdominal cramping after back surgery.

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Arora's Assessment

What might be happening

Based on the information you have provided, here are some possible explanations for your symptoms:

  • Infection: The sudden swelling, warmth, pain, and cloudy discharge suggest that you might have developed an infection at the site of the injury. Infections can occur when bacteria enter a wound, leading to inflammation and pus formation. Given your slight fever, this is a strong possibility.

    • Treatment: Infections typically require antibiotics, which a doctor can prescribe. They may also need to clean the wound and possibly drain any abscess if one has formed.
  • Cellulitis: This is a bacterial skin infection that can cause swelling, warmth, and pain. It often occurs after an injury that breaks the skin.

    • Treatment: Similar to other infections, cellulitis is treated with antibiotics. Keeping the area clean and elevated can also help reduce swelling.
  • Abscess: An abscess is a collection of pus that has built up within the tissue of the body. It can cause swelling, pain, and warmth.

    • Treatment: Abscesses often need to be drained by a healthcare professional, and you may need antibiotics to clear the infection.

What you can do

While you should seek medical attention promptly, here are some steps you can take in the meantime:

  1. Keep the area clean: Gently clean the wound with mild soap and water to prevent further infection.
  2. Apply a warm compress: This can help reduce pain and swelling. Use a clean cloth soaked in warm water and apply it to the swollen area for 10-15 minutes several times a day.
  3. Elevate the area: If possible, keep the swollen area elevated to help reduce swelling.
  4. Avoid touching or squeezing the area: This can worsen the infection or cause it to spread.
  5. Monitor your symptoms: Keep track of any changes in your symptoms, such as increased pain, swelling, or fever. You can use MDandMe to journal your symptoms, track progress, get insights, and share longitudinal medical notes with your provider.

What you should look out for

Seek medical attention immediately if you experience any of the following:

  • Increased redness or streaks of redness: This could indicate that the infection is spreading.
  • High fever or chills: A fever higher than 100.4°F or chills could indicate a more serious infection.
  • Difficulty breathing or swallowing: This could be a sign of a severe allergic reaction or spreading infection.
  • Worsening pain or swelling: If the pain or swelling continues to worsen despite home care, you should see a doctor.

Remember, while I can provide information and suggestions, I am not a substitute for professional medical advice. Please consult a healthcare provider for a formal diagnosis and appropriate treatment.

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4 mo ago

People Also Ask


What are the signs of an infection that I should be aware of?

Signs of an infection include increased redness, warmth, swelling, pain, and discharge from the affected area. A fever or chills can also indicate an infection.


How can I differentiate between cellulitis and an abscess?

Cellulitis is a diffuse bacterial skin infection that causes redness, swelling, and warmth, often without a distinct collection of pus. An abscess, on the other hand, is a localized collection of pus that can feel like a firm, painful lump under the skin.


What should I do if my symptoms worsen despite home care?

If your symptoms worsen, such as increased pain, swelling, fever, or if you notice red streaks spreading from the area, you should seek medical attention immediately as these could indicate a spreading or more serious infection.


Are there any specific precautions I should take given my diabetes and COPD?

With diabetes, you should be extra vigilant about infections as they can progress more rapidly. Keep your blood sugar levels under control and monitor the wound closely. With COPD, ensure that any medication prescribed does not interfere with your breathing or current treatment plan.


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