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History: A 59 year old white female was admitted to Barnes-Jewish hospital with the diagnosis of facial cellulitis. Six weeks prior to admission she first noticed erythema and swelling of the nose and presented to her primary care physician. She was diagnosed with erysipelas and treated with an oral cephalosporin. She failed to improve and subsequently developed erythema and swelling of her left eyelid. She presented to her ophthalmologist who diagnosed her with rosacea and prescribed doxycycline. Despite treatment she had increasing erythema and swelling of her nose and eyelid and presented to the hospital with severe pain.
Physical Exam: There was an irregular, crusted erythematous plaque affecting the nasal dorsum, tip and alae. The left upper eyelid was erythematous and swollen. There were tender, firm subcutaneous chords extending from her nose to her cheeks.
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