Puffy hand syndrome develops after long-term intravenous drug addiction. It is 
characterized by a nonpitting edema, affecting the dorsal side of fingers and 
hands with puffy aspect. Frequency and severity of the complications of this 
syndrome are rarely reported. Local infectious complications such as cellulitis 
can be severe and can enable the diagnosis. Herein, we report the case of a 
41-year-old man who went to the emergency department for abdominal pain, fever, 
and bullous lesions of legs and arms with edema. Bacteriologic examination of a 
closed bullous lesion evidenced a methicillin sensitive Staphylococcus aureus. 
The abdomen computed tomography excluded deep infections and peritoneal 
effusion. The patient was successfully treated by intravenous oxacillin and 
clindamycin. He had a previous history of intravenous heroin addiction. We 
retained the diagnosis of puffy hand syndrome revealed by a severe 
staphylococcal infection with toxic involvement mimicking a four limbs 
cellulitis. Puffy hand syndrome, apart from the chronic lymphedema treatment, 
has no specific medication available. Prophylactic measures against skin 
infections are essential.