Perineal fistulas’ differential diagnosis. Hidradenitis Suppurativa or Chron’s Disease?
KEY-WORDS: Hidradenitis Suppurativa; Chron’s disease; differential diagnose.
Hidradenitis Suppurativa (HS) is a chronic dermatologic condition in the apocrine gland-bearing skin, leading to deep, painful inflammatory lesions. The pathophysiology of this disease is not yet well understood; the most accepted hypothesis is that it has a multifactorial origin related to the patient’s immune and genetic systems and microbiota; in addition, it accompanies a systemic inflammatory disorder. It affects the patient under the biological e psychic prisms, making this pathology very excruciating for both patient’s body and mind. Treatment is based on the stage of the disease that occurs according to Hurley’s criteria and therapy covers exclusive clinical care or combined with surgical intervention. Objectives: to report the case of a patient who has a late diagnosis of Suppurative Hidradenitis justified by the delay in seeking medical care and the mistake in considering the clinical presentation suggestive of Chron’s Disease. Point out how differential diagnosis between these pathologies should be carried out ad perform a narrative literature review. Methods: the information described in this study was based on medical record review (CAAE: 96710818.3.0000.5496), literature review with data collection on the following plataforms: Pubmed, PMC, Medline, Lilacs and Scielo. The selected articles were the ones published in the last four years, written in English, Portuguese, Spanish or French. The retrospective search was restricted to indexed scientific articles describing research involving humans. Case Report: J.C.S.L, 36 years old, male, resident of upstate Mato Grosso, attended at a tertiary health unit located in the same state. He complained of perianal nodulation eleven years ago, located on the right buttock, associated with high-intensity pain and purulent-looking secretions. Disease worsened six years ago with an increase in the number of nodulations that have not shown improvement or worsening factors. According to the patient, these lesions went into spontaneous remission, however showed frequent recurrence in the same body region. After performing a local biopsy with anatomopathological analysis, patient was diagnosed with Chron’s Disease and remained for two years under a mistaken diagnosis. After undergoing colonoscopy, he was diagnosed with HS, receiving treatment with extensive local fasciocutaneous resection followed by healing by second intention, improvement in quality of life and remission of lesions so far. Conclusions: HS is an inflammatory, chronic and recurrent disease that must be early diagnosed in order not to worsening both the condition and it’s prognosis. In cases of perineal HS with differential diagnosis for CD with anorectal fistulas, biopsy does not have a significant value to distinguish these pathologies. For the investigation we suggest anamnesis focusing on the evolution of lesions, family history, eating habits, associated comorbidities and colonoscopy. We also recommend monitoring patients by a psychiatrist and/or psychologist due to stress, social isolation, depression and stigmatization that occurs due to HS.
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