Pilus Cuniculatus–induced Cellulitis of the Foot due to Puncture with Bristle Hair

A 17‐year‐old man was admitted to the hospital for an abscess with sinus formation of the right large toe. The lesion had started 6 months earlier with a focal area of swelling and induration, which was tender to the touch. The lesion had slowly progressed, forming an abscess that continuously drained to the surface. The patient initially received topical treatment with antibiotic creams and wet dressings without showing any improvement of his condition. Additionally, the increasing pain made the wearing of shoes intolerable and the patient was ordered bed rest. Systemic treatment with antibiotics was administered for a week (oral ampicillin, 500 mg QID) without any appreciable results. During his admission, the patient showed the clinical features of cellulitis. The area had a markedly red, hot, infiltrate, edematous appearance. The borders of the lesion were not sharply defined. Regional lymphadenopathy with lymphangitis was present and was treated with 1.5‐g erythromycin tablets TID and local saline dressings. After 6 days of treatment, his condition ameliorated and, when the swollen area returned to normal, the tip of a small black hair was observed protruding from the center of the abscess. The hair was removed with small forceps and examination showed this hair to be identical to those of the patient's shoe brush. At the same site (Fig. 1), a linear granulomatous response due to the chronic inflammatory process was seen. The size of the lesion and the hair are equal (Fig. 2). On both sides are two signs of injuries representing the terminus of the hair. Following removal of the hair and consecutive treatment with erythromycin tablets (1 g TID), the lesion healed completely, leaving only a small area of residual scarring.