REPORT OF A CASE
A 75-year-old white woman presented with chronic, recurrent, painless, perianal ulcers that rapidly progressed. A widow, she lived alone and had not traveled during the last 2 years. She never had systemic disease and denied use of any specific long-term medication except for suppositories, used frequently for chronic migraine. Physical examination revealed two para-anal "kissing" ulcers at 3 and 9 o'clock that were sharply demarcated and irregular, exhibited a friable, hemorrhagic, and purulent base, and coalesced at the fourchette (Fig 1). Proctoscopy and rectoscopy showed small hemorrhoid nodules but revealed an otherwise normal rectum and sigmoid. Smears from the ulcers yielded Escherichia coli, Pseudomonas aeruginosa, and Proteus mirabilis in culture but were negative for ameba and herpes simplex virus. Biopsy specimens from the margin and the base of the ulcers showed ample granulation tissue covered by necrosis and a dense inflammatory cellular infiltrate dominated by neutrophils.
Strohal R, Diem E. Progressive Perianal Ulceration. Arch Dermatol. 1992;128(8):1120. doi:10.1001/archderm.1992.01680180115019
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