Simple cases
Case 59
29 -year-old woman presents with recurrent painful, sometimes draining, nodules in the perianal and inguinal region, extending to the thighs and labia majora.
History
How long have you had this problem?
They started about 4 months ago.
Look for further characteristics as you pursue the diagnosis.
Do you feel sick or weak?
I think I have a fever and I just don't feel well.
Look for further characteristics as you pursue the diagnosis.
Is it painful?
They really hurt; I can't even sit at work.
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Does anyone in your immediate surroundings (partner, family, friends) have similar problems?
No, no one has mentioned anything.
Could this be an infectious disease?
Have you ever had problems like this before?
I had hemorrhoid surgery six months ago, but my problems then were completely different.
Could this be a recurrent disease?
Are you overweight? Do you smoke or drink to excess?
I am way overweight and I smoke.
Look for further characteristics as you pursue the diagnosis.
Do you have any other health problems?
I am overweight and smoke.
Look for further characteristics as you pursue the diagnosis.
Lesion
Choose the right efflorescences:
False. Try again or review the different types of lesions.
False. Try again or review the different types of lesions.
Several hyperpigmented scars are scattered about.
Correct. There are multiple livid nodules. Fluid can be expressed from some of them.
False. Try again or review the different types of lesions.
Diagnosis
Choose the right diagnosis:
False. This is not syphilis.
False. Lymphogranuloma venereum is associated with massive lymphadenopathy.
False. This is not candidal vulvitis (infection of the vulva with Candida albicans).
Correct. Hidradenitis suppurativa is a variant of acne (acne inversa) with invariable secondary bacterial infection.
False. The ulcers in chancroid are jagged and painful.
Therapy
Choose the right therapy(ies):
Correct. This is the standard approach. Radical excision is usually required.
False. Such patients require treatment.
False. This therapy is not sufficient.
False. This therapy is not indicated for this clinical problem.
False. CAREFUL!! This patient is allergic to penicillin.
Test
The following questions are related to the current case. Try to solve them.
