A 40-Year-Old Man With Painful, Rupturing Lesions

Elizabeth K. Satter, MD, MPH


July 27, 2021

Physical Examination and Workup

Upon examination, the patient is afebrile. He appears to be in a fair amount of discomfort while seated. On his left buttock is a large, indurated, hyperpigmented plaque with multiple coalescent erythematous and often fluctuant nodules. Scattered sinus tracts containing purulent material are observed, admixed with hyperpigmented hypertrophic and depressed scars (Figure). Similar lesions are noted on the right buttock and medial thighs, but the degree of involvement is significantly less. No lesions are seen in the axilla, and the rest of the physical examination is unremarkable.

Because the patient's presentation is unusual, a punch biopsy is performed and reveals an epithelial-lined sinus tract filled with keratin debris and neutrophils. The adjacent dermis is fibrotic and contains a mixed inflammatory infiltrate composed of lymphocytes, histiocytes, and plasma cells, as well as focal collections of neutrophils. Tissue cultures are negative.


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