Fulminant Perineal Boils

Lumps and bumps in the perianal region are a common referral for surgical care. In this report, we describe a less common cause of extensive perianal and perineal abscess. The case is of a69-year-old diabetic male who presents with an increasingly painful perineum. He is not overweight, but smokes heavily, and suffers from a long history (20 years) of recurrent flares of suppurative perineal cellulitis. No other significant medical or drug history was elicited. On examination, the affected skin was scarred, hyper pigmented and had multiple discharging sinuses suggesting a chronic inflammatory process. Fluctuant lesions extended from the scrotum anteriorly to the natal cleft posteriorly over a 20cm width around the perineum. He was afebrile with stable vitals. Laboratory parameters demonstrated a white cell count of 18×109/L and high C-reactive protein. Computed tomographic (CT) imaging was performed to exclude necrotizing fasciitis , which demonstrated localized superficial skin induration without crossing of fascia planes. Multiple low attenuation centers were visualized consistent with abscesses. In view of his acute perineal sepsis, he was taken to operating theatre. Under anaesthesia, examination revealed sinuses connecting the multiple abscesses for which all were drained and laid open. Cultures grew streptococcus gallolyticus and staphylococcus aureus. Histological features revealed chronic inflammatory infiltrate and granulation tissue.Clinical and pathological correlation led to a diagnosis of perineal hidradenitis

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Last date updated on September, 2024