Recurrent Bacterial Skin Infections in a Jiu-Jitsu Athlete

HISTORY: A 21-year-old male amateur jiu-jitsu athlete presented with a 3-day history of fever, chills, and malaise. He noticed a pimple-like lesion near his face a week prior, which has since grown in size and number in surrounding area. The patient reported multiple recurrent abscesses and cellulitis over the past year, disrupting his training and competition. His most recent infection occurred a month ago which was cellulitis on his face that spread into his ear requiring an extensive coarse of oral antibiotics. PHYSICAL EXAMINATION: Numerous painful pustular lesions noted on the face with surrounding areas of erythema. Multiple tender palpable lymph nodes identified in the parotid and submandibular areas. DIFFERENTIAL DIAGNOSIS: Group A bacterial infection Herpes gladiatorum Traumatic injury of the skin TESTS AND RESULTS: Patient was febrile with mildly elevated tachycardia. Lab tests was remarkable for leukocytosis with neutrophilia and elevated inflammatory markers. Culture taken from the lesion grew MRSA and a nasal swab confirmed MRSA colonization. FINAL WORKING DIAGNOSIS: MRSA skin infections likely due to colonization and exposure to high-contact athletic environments. TREATMENT AND OUTCOMES: The athlete was treated with an extended coarse of oral antibiotics (sulfamethoxazole and trimethoprim). He was referred for a decolonization regimen with chlorhexidine washes, nasal mupirocin ointment. He received guidance on hygiene and environmental controls, such as frequent equipment sanitization. The athlete returned to training two weeks later but had another infection six months later, requiring additional antibiotics.