The patient is a 56-year old male presenting to the emergency department complaining of redness, swelling, and pain of his right forearm. One week prior to arrival, he was injecting cocaine when the needle tip broke off under his skin. He developed cellulitis secondary to a methicillin-resistant Staphylococcus aureus (MRSA) infection.

The patient was hospitalized, treated with intravenous vancomycin, and the needle was surgically extracted using ultrasound guidance. The patient did well. Treatment was successful because of appropriate antibiotics, extraction of the foreign body, and adequate tissue penetration of the vancomycin. He was discharged on hospital day nine.

IV drug abusers commonly develop skin and soft tissue infections. Cellulitis may progress to more serious illness if left untreated. Pyogenic myositis, necrotizing fasciitis, osteomyelitis, septic arthritis, abscesses, and bacterial endocarditis could develop. Patients sometimes present subacutely with retained needles. Use of imaging techniques to detect and treat complications is imperative. Ultrasound-guided removal of foreign bodies is effective. MRI and CT scans are invaluable for detecting deep complications progressing from cellulitis require aggressive MRSA infections require aggressive treatment with appropriate antimicrobials for improvement, particularly in patients with human immunodeficiency virus (HIV). Other infective agents should be considered when osteomyelitis is one of the complications.