Is Celery To Blame For This Allergic Reaction?

A 47-year-old woman cut her finger while chopping celery earlier in the week. For the past 4 days, she has applied an antibiotic ointment to the wound, but the site has become itchy and more red and swollen.

What are you looking at here?

A. Bullous impetigo.
B. Cellulitis.
C. An allergic reaction to celery.
D. An allergic reaction to the antibiotic ointment.
E. Herpetic whitlow.

(Answer and discussion on next page.)

Answer: Allergic reaction to neomycin

This patient had an allergic reaction to neomycin in the antibiotic ointment, D. Pruritus and inflammation without pain are clues to the diagnosis. The finger healed after the ointment was stopped, and a topical corticosteroid cream was applied.
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The bullae of bullous impetigo usually are not as red and swollen as this lesion, and the surrounding area is more erythematous. Cellulitis does not feature bullae and is also more erythematous than the lesion seen here. An allergic reaction to celery would be confined to the cut in the skin. Although herpetic whitlow resembles this patient’s lesion, risk factors, such as occupational exposure to human saliva, for the usually painful herpes simplex virus infection were absent.  ■