Chronic, draining perianal sinuses.

Photo Quiz Chronic, Draining Perianal Sinuses NEELOFER SOHAIL, M.D., and JEANNE P. SPENCER, M.D., Conemaugh Memorial Hospital, Johnstown, Pennsylvania RENEE MATHER, M.D., Mathur Health Care, Johnstown, Pennsylvania A 46-year-old man with a history of alcohol abuse and hemorrhoids presented with a perianal and perineal rash of three to four weeks' duration. It was associated with severe tenderness and a small amount of discharge. On examination, a violaceous erythema with a rim scale on the gluteal crease and perineum (Figure 1) was noted. He had severe inflammation with multiple crypts and abscesses around the anus. There was a short period of improvement after he was treated with 14 days of cefazolin (Ancef). After several weeks, the lesion recurred with extension to the perineal area and was associated with draining sinuses (Figure 2). Colonoscopy results were negative for changes consistent with Crohn's disease. Herpes culture and syphilis serology were negative.