A 25-year-old white woman presented with a 4- to 6-week history of 2 subcutaneous, nonpainful, red nodules of insidious onset on the lower part of her legs. Physical examination revealed bilateral erythematous, subcutaneous nodules located on the anterior aspect of the lower area of the legs. The lesion on the right leg was a 0.4-cm, ill-defined, nontender swelling, and the lesion on the left leg was a 1.5-cm, firm, tender, erythematous, ulcerated nodule (Figure 1). The results of the rest of the physical examination were unremarkable. A punch biopsy specimen from the left leg showed suppurative and necrotizing granulomatous dermatitis, perifolliculitis, and panniculitis (Figure 2). Numerous acid-fast bacilli were noted within dermal and subcutaneous abscesses (Figure 3). Tissue cultures were positive for Mycobacterium chelonae at 3 days. Sensitivity results revealed high in vitro susceptibility to clarithromycin and ciprofloxacin hydrochloride, with intermediate sensitivity to trimethoprim-sulfamethoxazole. The patient was treated with ciprofloxacin and clarithromycin for 8 weeks after consultation with the Infectious Disease Division of the Naval Medical Center San Diego, San Diego, Calif. After 2 weeks of antibiotic therapy, the lesion on the right leg resolved and the size of the lesion on the left leg was reduced by 75%. At 10 weeks, however, the nodule on the right leg rapidly enlarged and suppurated, requiring incision and drainage (Figure 4). Cultures again yielded M chelonae at 3 days. Subsequently, extensive debridement of all necrotic tissue down to the anterior compartment muscle fascia of both legs was performed. Histopathologic examination of the debrided tissue showed follicular abscess formation, suppurative granulomas, and sinus tracts (Figure 5 and Figure 6) Numerous acid-fast bacilli were visualized with Fite stains. After 6 months of antibiotic therapy with clarithromycin, ciprofloxacin, and trimethoprim sulfate–sulfamethoxazole, the lesions resolved, and since then, there has been no recurrence (10 months). Before the onset of the disease, the patient had received pedicure treatments at a local nail salon (salon A) once a month for 3 months. She noticed that the disease had developed within 1 week of her last pedicure appointment. She also noted that she had shaved her legs with a razor blade before each appointment. This case was investigated by the County of San Diego Office of Public Health, San Diego, Calif, and the California Department of Health Services, Berkeley. On April 2, 2001, environmental specimens were collected from 4 of salon A's whirlpool footbaths for mycobacterial culture. The laboratory examination of these specimens by the County of San Diego Office of Public Health found that all 4 whirlpool footbaths were contaminated with RGM. Footbath isolates identified as M chelonae and Mycobacterium fortuitum were sent to the Centers for Disease Control and Prevention, Atlanta, Ga, for molecular comparison with an M chelonae isolate from the patient. Pulsed-field gel electrophoresis revealed that more than 1 strain of M chelonae was present in the whirlpool footbaths; several of the M chelonae isolates from the footbaths (salon A) were indistinguishable from the patient's isolate (Figure 7). After documenting this link between patient disease and salon A, the County of San Diego Office of Public Health canvassed local physicians in attempt to find other cases that might be related to this salon. No other cases were identified at that time, but over several months, 5 additional cases of RGM furunculosis related to pedicures (including 3 not described herein, 2 of which were M fortuitum infections) were reported, including 2 involving women who frequently received pedicures at salon A.