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Development of a Rash After Hot Tub Use


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Am Fam Physician. 2015 Sep 1;92(5):387-388.

A man presented with a rash that appeared one to two days after he used a hot tub. He developed chills and a fever of 102°F (39°C) the day after the rash appeared. The rash continued to spread and the fever persisted even though he had been taking oral trimethoprim/sulfamethoxazole for two days.

Physical examination revealed four or five superficial, tender, isolated, painful, erythematous nodules in bilateral axilla that were fluctuant and 0.5 to 1 cm in size (Figure 1). Incision and drainage produced a small amount of thick, purulent exudate from each nodule. The erythematous nodules on his abdomen were 1 to 3 mm in size and were not fluctuant. There was a pustule with surrounding erythema on his right calf.

Figure 1.


Based on the patient's history and physical examination findings, which one of the following infections is the most likely diagnosis?

A. Clostridium perfringens.

B. Pseudomonas aeruginosa.

C. Staphylococcus aureus.

D. Streptococcus pyogenes.


Address correspondence to Emily K. Snodgrass, MD, at Reprints are not available from the author.

Author disclosure: No relevant financial affiliations.


1. Mena KD, Gerba CP. Risk assessment of Pseudomonas aeruginosa in water. Rev Environ Contam Toxicol. 2009;201:71–115.

2. Stevens DL, Bisno AL, Chambers HF, et al.; Infectious Diseases Society of America. Practice guidelines for the diagnosis and treatment of skin and soft-tissue infections [published corrections appear in Clin Infect Dis. 2005;41(12):1830, and Clin Infect Dis. 2006;42(8):1219]. Clin Infect Dis. 2005;41(10):1373–1406.

3. Centers for Disease Control and Prevention. Pseudomonas dermatitis/folliculitis associated with pools and hot tubs—Colorado and Maine, 1999–2000. MMWR Morb Mortal Wkly Rep. 2000;49(48):1087–1091.

This series is coordinated by John E. Delzell, Jr., MD, MSPH, Assistant Medical Editor.

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