- 29 year old man
- Itchy rash in groin for 4 days
Thin-walled pustular vesicles, some of which have ruptured
Microscopy of vesicle fluid:
- +++ polymorphs
- gram positive cocci in clusters
Staphylococcal bullous impetigo
He was treated with flucloxacillin, together with valaciclovir pending result of Herpes simplex PCR.
At review a week later, the lesions had healed. HSV PCR was negative and culture of vesicle fluid resulted in a heavy growth of Staphylococcus aureus.
Staphylococcal genital infections are fairly common, and usually present as furunculosis or crusting impetigo. Bullous impetigo is seen occasionally, and may be difficult to distinguish from other vesiculating rashes, such as those caused by herpesviruses and vesiculating dermatoses.
In this case, a gram stain of vesicle fluid showed organism with typical staphylococcal morphology, thus allowing a (fairly) confident diagnosis to be made at presentation, with prompt introduction of specific antibiotic therapy.
Dated December, 2008