Blue Pseudochromhidrosis Secondary to Cellulitis Caused by Pseudomonas stutzeri

Pseudochromhidrosis is an uncommon dermatological condition in which eccrine sweat, normally colorless, acquires pigmentation upon contact with exogenous chromogenic substances on the skin surface, including chromogenic microorganisms. We report the case of an 88-year-old man who presented with bluish sweating and blue staining of the skin and nails seven days after sustaining trauma to his right leg at a construction site, which progressed to cellulitis with an ulcerated lesion. Alcohol cleansing temporarily removed the discoloration, which reappeared shortly thereafter. Microbiological culture of the ulcerated lesion revealed Pseudomonas stutzeri susceptible to quinolones. Targeted therapy with intravenous levofloxacin was initiated, resulting in the marked improvement of the bluish discoloration within 24 hours. A review of the available literature did not identify prior reports of Pseudomonas stutzeri associated with infectious pseudochromhidrosis. This case expands the recognized infectious spectrum of this condition and highlights the importance of microbiological evaluation in patients presenting with anomalous sweat discoloration.