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case_images: Preoperative perianal MRI.
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case_images: An old sinus tract in the posterior perianal space with fibrous tissue formation on the posterior wall of the anal canal was also observed, suggesting a correlation with the patient's medical history (Fig. 1).
case_images: Multiple papules on the patient's abdomen.
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case_images: On Day 14, the patient's temperature was 37.1 C with improved myalgia but worsening knee pain, fatigue, oral ulcers, and abdominal papules with pustules (Fig. 2).
case_images: Color Doppler ultrasound of the right inguinal lymph node.
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case_images: Measuring 23 x 12 mm on ultrasound, without abnormal blood flow on Color Doppler Flow Imaging (Fig. 3).
case_images: Pelvic CT on the 15th day after surgery.
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case_images: CRP (123.2 mg/L). Computed tomography (CT) scans revealed: (i) Local fibrous cord in the lower lobes of both lungs. (ii) Multiple small nodules in both lungs. (iii) Splenic enlargement. (iv) Possible inflammatory changes in the right pelvic and inguinal regions with multiple enlarged lymph nodes (Fig. 4).
case_images: The abdominal papules and pustules had disappeared on the 27th day following surgery.
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case_images: After 5 days of treatment, the patient's body temperature gradually returned to normal, the pain in the right inguinal lymph node subsided, its size decreased to 2 x 2 cm, the oral ulcers began to heal, and the abdominal papules and pustules resolved (Fig. 5).
case_images: Pelvic CT on the 27th day after surgery.
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case_images: C-reactive protein 21.8 mg/L, PCT 0.09 ng/ml. CT re-examination indicated that the right inguinal lymph nodes had decreased in size (Fig. 6).