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Frequent swellings in armpits, which bring high fever
Sep 25, 2000

I have an HIV/AIDS patient who keeps getting swellings in armpits, that come with high fever. These swellings go after taking antibiotics (ampicillin-cloxacine) only to reappear after a few days. They are quite painful, but small. They can only be felt by finger but cant be seen. They can appear in either armpit or both. This has been happening for about 2 years. Please help. What can we do?

Response from Dr. Feinberg

If your patient has decent CD4 cells, then this sounds most like hidradenitis suppurativa to me. This can occur in the groin as well. It may be recurring quickly because the patients isn't getting a long enough course of an anti-Staphylococcal antibiotic. I usually use dicloxacillin (or clindamycin in PCN-allergic patients) for at least 10 days. These infections have a way of burrowing under the skin and causing scarring that makes it difficult for the pus to drain; sometimes they need to be incised & drained, and some luckier people can get them to drain spontaneously with the application of warm moist compresses. This is a disease that is chronic and recurring, and is most likely incidental to your patient's HIV.

That said, if your patient has dangerously low CD4 cells, this could be due to any one of a number of opportunistic infections or malignancies. And even people with low T cells can get hidradenitis.

Urinary tract infection, help!
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