A 40-Year-Old Man With Recurrent Painful Nodules

Elizabeth K. Satter, MD, MPH

Disclosures

March 15, 2016

Editor's Note:
The Case Challenge series includes difficult-to-diagnose conditions, some of which are not frequently encountered by most clinicians but are nonetheless important to accurately recognize. Test your diagnostic and treatment skills using the following patient scenario and corresponding questions. If you have a case you would like to suggest for a future Case Challenge, please contact us.

Background

A 40-year-old Indonesian man presents with a 20-year history of recurrent painful nodules on his bilateral buttocks, gluteal cleft, and medial aspect of his upper thighs. The lesions often spontaneously rupture and result in sinus tracts or scarring. The patient previously had an excision of a diffusely involved area on his left buttock followed by a split-thickness skin graft; however, within 6-8 months, new lesions developed at the site of prior treatment.

The patient is otherwise healthy, with no history of facial or back acne, pseudofolliculitis barbae, or dissecting scalp folliculitis. The patient denies arthralgia, gastrointestinal or genitourinary symptoms, and fever or chills. He denies smoking, and his total body mass index is within normal limit. No family history of similar lesions is reported.

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