History and admission findings: A 15-year-old boy presented with painful nodules on his palms and discrete pustules on the forearm. Two days earlier he had taken a bath in a new whirlpool.
Investigations: Bacteriological examination of the pustules revealed Pseudomonas aeruginosa. The cervical and axillary lymph nodes were inconspicuous.
Treatment and course: The dermal infection with Pseudomonas aeruginosa was treated with i.v. piperacillin 4 g/tazobactam 0,5 g twice daily. Furthermore, the patient received 400 mg ibuprofen twice daily per os. Seven days later all symptoms had resolved.
Conclusion: Hot tubs are a potential source of cutaneous infections with the gram-negative rod Pseudomonas aeruginosa. The most common clinical manifestation of these infections is "hot tub- or jacuzzi-folliculitis" with pustules mainly on the trunk and lymphadenopathy. In children and adolescents, the clinical picture may differ, with a predominance of tender reddish nodules on the palms or soles named "hot hand/hot foot syndrome". In general, the first-line antibiotic in an infection with pseudomonas aeruginosa is ciprofloxacin but it is not recommended in children and adolescents.
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