We report the case of a 40-year-old man who was being followed-up by the Palliative Care Service due to painful nodular glue lesions with purulent drainage.
She was histologically diagnosed with deep cystic follicle suppurative, compatible with conglobate acne, with positive culture for Staphylococcus aureus.
She was treated with prednisone (15 mg/day), isotetricine and rifampicin without improvement.
In addition, it was associated with a one-year history of weight loss of 25 kg and abdominal pain, with fever in the last weeks.
The patient was admitted to hospital.
Physical examination revealed cachectic lesions, with multiple nodular lesions in the gluliteal and perianal regions, with rigid zones, draining purulent material.
Laboratory tests revealed severe iron deficiency anemia (Hb: 7.2 g/dl), increased acute phase reactants (PCR:13) and malnutrition data (albumin: 8.493 g/dl, cholesterol).
Crohns disease was diagnosed by observing pseudopolyps, ulcers and a mucus-like appearance in the rectum and transverse colon, as well as two fistulous orifices. The histological diagnosis was inflammatory bowel disease type.
Pelvic MRI showed a left perianal fistula extending from the left thigh.
High-dose steroids, 5-ASA, antibiotics and azathioprine were prescribed, with significant clinical and laboratory improvement and resolution of skin lesions.
In this case, the existence of another diagnosis (conglobate acne) together with the presentation of CD as perianal disease (PAD) led to a delay in diagnosis, which could be a major determinant in the development of these lesions.
