A 33-Year-Old with New, Painful ‘Lumps’ on Her Legs

Differential Diagnosis

• Folliculitis
• Furunculosis
• Mycobacterium marinum infection
• Ecthyma

Diagnosis

This patient was diagnosed with furunculosis, cutaneous abscesses associated with hair follicles. Carbuncles are a continuous collection of furuncles.

Furuncles are infectious, with the most common causative agent being Staphylococcus aureus (either methicillin-sensitive [MSSA] or methicillin-resistant [MRSA]). The infecting strain of Staphylococcus is usually colonized in the nares, umbilicus, or perineum.

Learnings/What to Look for

• Furuncles are painful and may have purulent drainage
• Furuncles usually occur on the face, neck, axillae, buttocks, thighs, and perineum
• Furunculosis most commonly affects males, especially adolescents and young adults
• Predisposing factors include Staphylococcus carriage, friction, malnutrition, poor hygiene, diabetes, hyper-IgE syndrome, and HIV infection
  
  

Pearls for Urgent Care Management

• Treatment is incision and drainage; warm compresses may facilitate drainage
• Furuncles may resolve within 2 weeks without treatment in uncomplicated patients
• Antibiotics (ie, cephalexin, TMP/SMX, doxycycline) may be used in febrile patients or patients in whom furuncles persist

Acknowledgment: Image and case presented by VisualDx (www.VisualDx.com/jucm).

Read more

• CA-MRSA Abscess Care And Treatment Guidelines In Urgent Care Practice
• Actinomyces Neuii As A Cause Of Vulvar Abscess