Obscure Skin Infection in a Morbidly Obese Patient: The Challenges of Diagnosis

Obesity is a complex and increasingly prevalent condition associated with significant morbidity and mortality. Increased susceptibility to skin and soft tissue infections is attributable to multiple factors, including immune dysregulation, impaired mobility, and the anatomical challenges posed by excess adipose tissue. In morbidly obese individuals, limited access to intertriginous areas, difficulties with repositioning, and overlapping comorbidities can delay the recognition and treatment of infections, potentially worsening clinical outcomes. This case report describes a 50-year-old morbidly obese Cuban American male who presented to a hospital serving an underserved community with suspected cellulitis or lymphangitis of the lower extremity. No definitive source of infection was identified. Despite early empiric treatment, clinical deterioration ensued, resulting in respiratory failure and septic shock. The patient ultimately required tracheostomy and percutaneous endoscopic gastrostomy (PEG) tube placement, as well as long-term acute care. The case underscores the diagnostic challenges inherent in evaluating cutaneous and subcutaneous infections in patients with severe obesity. It highlights the importance of maintaining a high index of suspicion and employing a methodical approach to skin assessment in this population to ensure timely diagnosis and intervention in order to optimize clinical outcomes.