Axillary pain and swelling
A 44 year old man with a body mass index of 41 kg/m2 presented to the surgical outpatient clinic with a three month history of swelling, erythema, and small tender lumps in his right axillary region (fig 1). His general practitioner had prescribed oral antibiotics (three courses) and although the symptoms subsided temporarily, the condition soon recurred. He had had this problem on and off for the past 20 years (recurrent abscesses, pain, discharge, and occasional bleeding) and had had three surgical interventions (incision and drainage procedures), but with limited success. The patient had similar problems in the left axilla (fig 2) and both groins. He was a former smoker and his medical history was unremarkable apart from acne, varicose veins, and depression.
Diagnosis is based on clinical findings, and no investigation is needed in the acute stages of the disease.7 Treatment with empirical oral antibiotics (an anti-staphylococcal and anti-streptococcal