GP Stories - Onion Armpits

Sometimes face to face is much needed to get a better idea of what is going on with a patient. Usually there are obvious reasons to bring a patient in for a face to face consultation: young children, chest pain, abdominal pain, shortness of breath and more. However the hard part of this age of remote consulting is deciding on when someone needs to come down. It could be the ambiguous history or the story that doesn't quite make sense - sometimes it's better to bring them down. However there is the constant thought of not creating too much covid-19 risk in your practice or putting too much pressure on your clinic.  

One lady called in complaining of a weird smell from her armpits, she was smelling onions there. It wasn't just her though, her husband had also been smelling it. It was causing understandable anxiety and also meant they had to sleep in separate bedrooms, which was causing issues in their relationship. She had tried all manner of body washes and deodorants but the smell was ever pervasive. She seemed otherwise well though and it had me stumped. I asked her to come down so I could smell for myself.

Some smells in medicine are what's known as pathopneumonic. Hepatic fetor (horrible stench from the mouth) is indicative of liver disease, a sweet smell from the mouth of a diabetic can be a sign of diabetic ketoacidosis and the characteristic bad smell from a wound can indicate pseudomonas. An interesting article from the British Journal of General Practice comments that it is an underused part of clinical practice in primary care. 

When I saw her,  I got right to it and we smelt her armpits and lo and behold, it was an odd smell. I couldn't quite put my finger on it however, not quite onion but definitely root vegetable. It definitely was not normal. I took a swab from the area and sent her for some routine blood tests. I was still stumped even after seeing and smelling her, perhaps it was a new long-covid sign? Hopefully the tests will get to the bottom of this, but maybe we may never know. If does end up being a new undiscovered condition, I'll be happy to not put my name to it however.