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A 48-Year-Old Woman from Thailand With Fever and Disseminated Cutaneous Abscesses


Clinical Presentation

History

A 46-year-old Thai woman is transferred to a German clinic for tropical diseases with a 2-month history of recurrent cutaneous and subcutaneous abscesses, progressive lymphadenopathy and weight loss.

Despite various antibiotic therapies, clinical symptoms and inflammatory markers had deteriorated, resulting in hospital admission. Pus and blood cultures did not yield any growth, and histopathology of a lymph node biopsy showed non-specific lymphadenitis. The symptoms started 6 to 8 weeks after her return from a family visit to northern Thailand. During her stay the patient had suffered from high fever, dry cough and fatigue.

Clinical Findings

A 46-year-old woman, 158 cm, 65 kg (BMI 26 kg/m 2 ), afebrile, blood pressure 130/80 mmHg, pulse 80 bpm.

Enlarged, tender cervical, nuchal, inguinal and axillary lymph nodes. Massive, tender swelling of the upper eyelids. Disseminated fluctuant cutaneous and subcutaneous abscesses with surrounding erythema ( Fig. 61.1 ), discharge of pus on slight pressure. Painful swelling of the left elbow. Otherwise normal physical examination.

Fig. 61.1, Subcutaneous abscess on the left forearm.

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