Diagnosis: Cellulitis
Treatment: Inpatient admission
The inpatient admission was medically necessary.
The patient meets the initial criteria for IV treatment and admission for cellulitis/abscess given by the Infectious Diseases Society of America (1) for a multitude of reasons that include having a cellulitis associated with deep structures (lacrimal glands, orbit, and brain). Furthermore, the fact that she was homeless meant that admission in such a case (even if it were a milder presentation) was necessary as outpatient treatment would have been difficult and potentially harmful. Finally, it is difficult to imagine how and why this patient could have been treated as an outpatient when she was transferred to a tertiary institution because the current hospital and its physicians clearly stated they themselves were not equipped to treat this case as an inpatient in their hospital. Failure to admit and treat this patient (or treating this patient as an outpatient) could lead to permanent neurological deficits, including blindness, or death.