Green Foot Syndrome

Comment P. aeruginosa is a gram-negative bacillus, which may infect the skin or deeper tissues. Excessive moisture and occlusive conditions are necessary for colonisation of this bacterium and the resulting clinical manifestations.1 Green foot syndrome (GFS) is an uncommon cutaneous disease caused by P. aeruginosa and is frequently associated with poor hygiene, humidity and immunosuppression. 2 Trench foot syndrome (TFS) is a related condition, common in military personnel, but is characterised by an acute onset and more aggressive course if not treated appropriately.3 On the other hand, GFS is less aggressive and has a chronic evolution. In GFS, chronic painful ulcers develop on the feet as a result of a P. aeruginosa infection, which can penetrate at sites of maceration, particularly, if there is dermatophytic infection in the foot.1 As in other cutaneous infections by this bacterium, a characteristic yellow-greenish colour is seen in these ulcers.4 When deep infection is suspected (i.e. painful sensation, fever, chills, etc.), antibiotic treatment should be administrated combined with topical solutions. The current patient developed a chronic skin disease consisting in painful ulcers on the dorsum of the right foot, with intermittent course, for five years. While he did not have a medical history suggestive of immunosuppressive disease and excluding any previous history of parenteral drug abuse, he did use closed and tight shoes where poor hygiene and excessive sweating facilitated the rapid growth of P. aeruginosa which most likely led to GFS.