Folliculitis with Secondary Bacterial Infection Following Manipulation

Case at a Glance

A 24-year-old male presents with a tender nodule in the axillary region that developed erythematous spreading after attempted drainage, concerning for secondary bacterial infection.

Patient's Story

The patient noticed a painful, firm bump just outside his left armpit on Friday. Initially believing it to be an ingrown hair, he attempted to express the contents himself. Within 2 hours of manipulation, he observed the development of surrounding erythema and rash. The lesion produced purulent material mixed with blood during expression. The patient reported recent travel history including beach vacation 3 weeks prior with exposure to communal facilities (hotel pool, hot tub, and towels).

Initial Assessment

Physical examination revealed a central pustular lesion with surrounding cellulitis in the axillary region. The area showed progressive changes over 72 hours: initial acute inflammation with intense erythema immediately post-manipulation, followed by expansion of the affected area with decreased intensity of redness but increased surface area involvement. No systemic symptoms reported.

The Diagnostic Journey

The clinical presentation suggested folliculitis complicated by secondary bacterial infection following trauma from manipulation. Differential diagnosis included: 1) Staphylococcal or streptococcal cellulitis, 2) Hidradenitis suppurativa, 3) Furuncle with spreading infection. The patient's concern about possible methicillin-resistant Staphylococcus aureus (MRSA) infection was noted given the rapid progression and recent exposure to communal facilities.

Final Diagnosis

Folliculitis with secondary bacterial cellulitis, likely staphylococcal, following traumatic manipulation of the lesion.

Treatment Plan

Recommended immediate medical evaluation at urgent care facility for proper assessment and potential bacterial culture. Anticipated treatment would include topical or systemic antibiotics based on severity, warm compresses for comfort, and strict wound care instructions. Patient education provided regarding avoiding manipulation of similar lesions in the future.

Outcome and Follow-up

Patient was advised to seek medical attention promptly given the spreading nature of the infection. Follow-up would be determined based on urgent care evaluation and response to prescribed treatment. Monitoring for signs of systemic infection or treatment failure was recommended.