Pseudomonas folliculitis: a complication of the lockdown hot tub boom? Lessons from a patient

Abstract

An otherwise fit 58-year-old male presented with a sudden-onset rash on the buttocks and tenderness under the arms and left breast. His 25-year-old son had a similar rash on his torso and tenderness around the nipples bilaterally. Both patients were apyrexial. Over the next 24 hours redness developed at the site of tenderness under the arms and around the areolae. The family had bought a hot tub 3 weeks earlier and the father and son had longer immersion in the water compared with other family members, who were not affected.On examination there were tender erythematous nodules in the axillae (Figure 1) and around the left areola (Figure 2). There was follicular erythema with pustules over the buttocks (Figure 3). The son had similar changes in the axillae and around the areolae bilaterally with papules and pustules over the back (Figure 4).After 2 days pus started to discharge from the breast nodule of the son and a swab grew Pseudomonas aeruginosa. A diagnosis of Pseudomonas folliculitis with mastitis and axillary lymphadenopathy was given. Both patients took 500 mg ciprofloxacin twice daily for a week with complete resolution of the affected areas.The hot tub was drained, cleaned with domestic bleach products, and rinsed.