Atypical Skin Infection in a NCAA Division I Football Player

Abstract

2033 HISTORY: A 21 year old male; who is a member of a NCAA football team initally presented with an area of increased erythema and warmth, localized swelling, and increased pain involving the lateral aspect of his left elbow. The area involved initally suffered localized abrasions 6 days earlier. At the time of original exam the patient had no systemic findings including: no fever, chills, nausea, vomiting, significant weight loss, and further skin lesions. The patient is noted to have suffered from a herpetic lesion rash one year prior without any further known incidences. The inital treatment included conservative therapy with proper antibiotic coverage. The lesion was lanced 1 day later; and moderate amount purulent material was expressed. The wound was then kept open and allowed to heal over the next 2 weeks. However, approximately 3 weeks after the initial presentation the patient presented with multiple pustules and furuncles involving his abdomen of various sizes with similar symptoms as above. PHYSICAL EXAMINATION: Vital signs were within normal limits; temperature – afebrile. Skin – multiple pustules located on the abdomen with localized erythema, warmth to the touch, and painful to palpation; one furuncle located in the left periumbilical region measuring 1cm in diameter, with minimal drainage, surrounded by localized indurated tissue, and painful to palpation; minimal fluctuance was noted involving the furuncle. No futher lesions were noted. Lymph – minimal localized lymphadenopathy was noted in both inguinal and axillary regions bilaterally. Lung – normal. Cardiovascular – normal. Abdominal – normal; except for pain with palpation as described above. DIFFERENTIAL DIAGNOSIS: Bacterial infection Viral infection Fungal infection Foreign Bodies TEST AND RESULTS: Wound cultures including aerobic/anaerobic with sensitivity – MRSA Culture of the artifical turf – multiple organisms including unidentified staph species. CBC – WNL FINAL WORKING DIAGNOSIS: Methicillin −resistant staphylococcus aureus (MRSA) skin infections – folliculitis, furuncle, and abcess. TREATMENT AND OUTCOMES: Appropriate antibiotic coverage Incision and drainage of lesions under localized anesthesia. Keep lesions clean, dry, and covered during practice. Educate players, coaches, and athletic trainers on CDC recommendations for prevention. Keep athletes with abcesses that have continued prain and/or drainage held out of contact. Try to identify and eliminate the source of the MRSA. Daily follow up. Inspection of all skin lesions. Currently the patient is doing fine; however he has multiple teammates being treated for similar infections.