Case Presentation
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.