Klebsiella oxitoca folliculitis mimicking tinea barbae in a diabetic man

A 55-year-old male dairy farmer was admitted to our hospital with a skin infection on the neck and face. He was apparently in good general health, and his medical history was unremarkable. He reported that, 50 days before admission, a pruritic red maculopapular rash had developed on the anterior region of his neck. This rash failed to improve after a 10-day course of trimethoprim-sufamethoxazole and fluconazole; rather it progressively worsened. On admission, examination revealed confluent follicular papulae-pustules with purulent-hematic exudation and crusting, on an erythematous-edematous area extending over the anterior region of the neck, chin and mandible (Fig. 1); hairs within the affected area were not compromised. Body temperature was 38.5 °C, and cervical nodes were not appreciable. Results of routine laboratory investigations were: white blood cells (WBC), 8090/mm3 (85% neutrophils, 10% lymphocytes and 4% monocytes); erythrocyte sedimentation rate, 72 mm/h; C-reactive protein, 44.8 mg/100 mL; serum glucose, 453 mg/100 mL. Quantitative measurements of serum levels of immunoglobulins M, G, A, and E, total complement activity, complement factors C3 and C4, and alpha-1-antitrypsin were within normal limits. Swabs for bacteriological and mycological analysis were taken from pustules. While waiting for the results of the cultures, insulin therapy was started at 40 IU/day, because of hyperglycemia. Mycological culture was negative, while bacteriological culture yielded Klebsiella oxitoca. The patient was treated with ceftazidime 4 g/day intravenously and amikacin 1 g/day intramuscularly for 3 weeks, and a slow and progressive improvement, with no formation of scars or alopecic areas, was observed (Fig. 2). © 2004 The International Society of Dermatology.