II. Epidemiology

  1. Relatively rare in the U.S. due to Hib Vaccine and Pneumococcal Conjugate Vaccine
  2. Age <5 years old (esp. <12 months of age)

III. Causes

  1. Haemophilus Influenzae Type B (most common cause, esp. pre-Hib Vaccine era)
  2. Streptococcus Pneumoniae

IV. Symptoms

  1. Prodromal symptoms (onset up to 8 hours before rash onset)
    1. Coryza
    2. Fever

V. Signs

  1. Significant cheek swelling accompanied by erythema and purple discoloration of the malar region
  2. Mild Trismus
  3. Low grade fever

VI. Differential Diagnosis

  1. See Malar Rash
  2. Facial Erysipelas (Group A Streptococcal Cellulitis)
    1. Focal area on face of Paresthesia or pain, followed by rash developing, often in malar distribution
    2. May be preceded by Pharyngitis
  3. Staphylococcus aureus Cellulitis
    1. On the face, Staphylococcal Cellulitis may be indistinguishable from streptococcal Erysipelas
  4. Parvovirus B19 (Fifth Disease)
    1. Facial erythema (slapped cheek appearance) spares the chin and periorbital region
  5. Dental Abscess extension
  6. Wells’ syndrome
    1. Eosinophilic Cellulitis

VII. Management

  1. See Facial Erysipelas
  2. Exercise caution in the post-Hib Era with Buccal Cellulitis and consider management as Facial Erysipelas
  3. Buccal Cellulitis was historically treated to cover for HaemophilusInfluenzae Type B
    1. Ceftriaxone 50 mg/kg IV every 24 hours has been used for severe infections
    2. Trimethoprim Sulfamethoxazole (Septra, Bactrim) has been used for oral antibiotic management

VIII. Prevention

IX. References

  1. (2019) Sanford Guide, accessed on IOS 11/20/2019
  2. Walker (1990) Am J Emerg Med 8(6):542-5 [PubMed]

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