A 19-year-old man presented to the hospital with fever, bilateral axillary pain and swelling for four days. On presentation, temperature was 38.6°C, pulse was 105 beats per minute, and blood pressure was 142/73mmHg. Examination of bilateral axillae revealed papular and pustular lesions involving the hair follicles along surrounding erythema, exquisite tenderness, and fluctuant nodules (Figure 1).

Laboratory testing revealed a white blood cell count of 23.3 x 10⁹/L and creatinine of 1.3mg/dL. He was treated with vancomycin and ceftriaxone and underwent incision and drainage of the fluctuant nodules with purulent yellow drainage. Over the next two days, he remained febrile with persistent leukocytosis. Gram stain of the wound drainage showed gram positive cocci in clusters. On hospital day four, wound culture grew Pseudomonas aeruginosa.

On further questioning, the patient denied hot tub or swimming pool exposure but reported regular use of a bath sponge when showering. He was treated with ciprofloxacin 500mg twice daily for one week with resolution of his symptoms.