Abstract
CASE HISTORY: The patient is a 15-year-old female who plays volleyball and basketball with a medical history that includes a diagnosis of Juvenile Idiopathic Arthritis at the age of eight. The patient’s chief complaint is a rash only on her legs and abdomen. She denies pain with the rash but admits that it has been active for about 4 weeks. The patient denies changing laundry detergents or contact with any new pets or plants. The patient admits to not showering after basketball practice because practice is during the first period of the school day, and time does not allow for a shower. PHYSICAL EXAM: Exam shows small, red, pus-filled bumps on the patient’s legs, both posterior and anterior, and on the abdomen from the level of the xyphoid process to the umbilicus. DIFFERENTIAL DIAGNOSES: Staphylococcus Aureus, Bacterial Folliculitis, Contact Dermatitis, heat rash. TESTS & RESULTS: The patient was advised to wash her basketball practice gear and shower daily. The patient also used antibacterial hand wipes to wipe her body down after practice, but before class. She was advised to wash her sheets and all other bedding. After two weeks of this routine, the rash did not diminish. The patient was referred to a dermatologist after consultation with her rheumatologist, where a punch biopsy was obtained. FINAL DIAGNOSIS: Bacterial Folliculitis DISCUSSION: While mild, long-lasting bacterial folliculitis is not commonly seen in the athletic setting, this patient brought a unique medical and, therefore, pharmacological history. Juvenile Idiopathic Arthritis itself can cause skin rashes that have pink to red papules; it does not cause bacterial folliculitis. However, the medications used to treat JIA, mostly TNF-inhibitors, can weaken the immune system, thereby increasing the patient’s susceptibility to skin infections. Paradoxically, the medication also reduces inflammation, pain, and swelling, so the eruption of the rash appears milder in this patient than it would have in another patient not on a TNF-inhibitor. OUTCOME OF THE CASE: The patient was prescribed 30 days of Doxycycline Hyclate. The rash dissipated for about 2 months, and then returned. Another round of antibiotics alleviated the rash to date. RETURN TO ACTIVITY AND FURTHER FOLLOW-UP: The patient was never removed from sports participation. She was encouraged to maintain her new personal hygiene regimen even after basketball season ended. Consultation with her rheumatologist revealed that while not commonly known, cases of bacterial folliculitis in JIA patients on TNF-inhibitor drugs have been reported as high as 38%. The patient is to follow up with both the dermatologist and rheumatologist if a third round of medication is needed within one calendar year.
Recommended Citation
Long, Melissa D.
(2026)
"Bacterial Folliculitis in a Patient with Juvenile Idiopathic Arthritis,"
International Journal of Exercise Science: Conference Proceedings: Vol. 2:
Iss.
18, Article 203.
Available at:
https://digitalcommons.wku.edu/ijesab/vol2/iss18/203