Severe Occupational Contact Dermatitis Following Recurrent Sewage Exposure in a Plumber

Occupational exposure to sewage-contaminated water may provoke severe cutaneous inflammation due to skin irritation and disruption of the skin’s protective barrier, leading to possible secondary bacterial infection. We present the case of a 62-year-old male plumber who was exposed to sewage-contaminated water during his work, developing severe cutaneous inflammation and possible subsequent bacterial infection. The involved areas included the lower extremities, hands, anterior aspects of the forearms, and face after cleaning a sewage-contaminated residential basement. Approximately one day after exposure, the patient developed symptoms following contact with contaminated water that had soaked through his clothes and into his shoes. Some of the contaminated water also came into contact with preexisting cuts on his hands. Telephone history confirmed that he had a similar eruption several years ago following a residential sewage exposure episode. There have been no other episodes of a similar nature unrelated to his residential sewage exposure episodes. Intense itching prompted a prolonged hot shower, which the patient reported caused additional thermal injury. Laboratory evaluation showed a white blood cell count of 9.06 × 10³/µL and serum lactate of 1.6 mmol/L; a culture was reportedly negative after five days, although the specimen type was not independently confirmed. The patient reported improvement within approximately two days of starting amoxicillin-clavulanate, with resolution after about a week of treatment, without concurrent medication or topical treatment. The patient is thought to have developed severe occupational contact dermatitis in the form of irritant contact dermatitis, most likely caused by his recurrent exposure to sewage-contaminated water at work, with allergic contact dermatitis and secondary bacterial infection remaining possible. This case illustrates the challenge of distinguishing severe occupational dermatitis from localized infection and secondary bacterial infection, particularly when improvement occurs with antibiotic therapy.