1186 Pseudomonas in the ‘hot tub’

• Published in: Archives of disease in childhood 2021-10, Vol.106 (Suppl 1), p.A263-A263
• Main Authors: Mallappa, Anupama, Middleton, Catriona, Cox, Stewart, Majethia, Aditi, Mcdonald, Lynne
• Format: Article
• Language: English
• Subjects: Abstracts; Antibiotics; Case reports; Children; Chlorine; Ciprofloxacin; Epidermis; Exanthema; Feet; Fever; Folliculitis; Ibuprofen; Infections; Jumping; Leukocytosis; Mucosa; Pain; Paracetamol; Patients; Pediatrics; Pseudomonas; Water pollution
• ISSN: 0003-9888; 1468-2044
• DOI: 10.1136/archdischild-2021-rcpch.458

Background Pseudomonas hot-foot syndrome is a skin infection of the soles caused by Pseudomonas aeruginosa. It is characterized by painful erythematous plantar nodules, typically occurring in children following use of Pseudomonas-contaminated pools. Similar involvement of the palms has been reported less frequently. It is clinically distinct from folliculitis caused by Pseudomonas.ObjectivesTo report a case of hot foot.MethodsElectronic records were used to collect dataResultsA previously well 8yr old presented to his GP with history of acute onset of blanching rash on most of his torso and excruciating painful lesions on his feet. Had been jumping on the trampoline bare feet and subsequently had been in the hot tub afterwards. This was 12 hours prior to the presentation. Interestingly his 5-year-old sister had similar rash, but no feet complaints and young uncle developed both similar rash and the feet complaints as our patient. All the three were on the trampoline and in the pool.The pain was severe in nature despite being on regular paracetamol and ibuprofen. He was unable to weight bear.He also developed high grade fever and headache prior to presentation.On examination: He was bright . Not systemically unwell . No mucosal involvement.Had a cold towel on his feet to ‘ease the pain’. The rash on his torso including buttocks, was widespread, maculo-papular erythematous blanching rash. Few of them looked like white head pimples.Both feet -widespread rash both feet, including sole margins. Red, papular, lumpy nodular, more prominent on the balls of the toes and the base of the metatarsals.No joint involvementThe working diagnosis was Hot Foot syndromeHis bloods showed a mildly elevated CRP 29mg/l. He was initially treated with IV antibiotics and changed to oral ciprofloxacin for a duration of 10 days. He remained well during the stayDiscussionThis condition typically occurs in young children. It is thought that children may have a thinner epidermis on their palms and soles compared with adults, and also that they may be more active in pool areas; this increases the risk for friction injuries and susceptibility to infection.Symptoms typically occur 6–48 hours following exposure to contaminated pools and include intense pain followed by swelling, redness, and warmth in the affected areas. Clinical course is usually benign, with rapid resolution. The condition does not typically require antibiotic therapy; however, leukocytosis and low-grade fevers may occur