Dubai Surgical Residents
Figure it out fridays
#68
54 year old male presented with multiple perianal swellings. The swellings had been on and off for a period of 30 years but this last crop had persisted for 16 months. There was no history of anal intercourse, instrumentation or radiation. He had no swellings in the axillae nor in the groins.
His weight was 67 Kg and height 1.78m with a body mass index of =21. Physical examination showed multiple perianal swellings with several sinuses discharging pus
Packed cell volume was 33%. The purulent discharge grew Staphylococcus aureus sensitive to ciprofloxacin.
The urea , electrolytes and creatinine were normal. Total leucocyte count was 14.3x109/L with differentials of neutrophils 58%, lymphocytes 34%, monocytes 6% and eosinophils 2%. There was a left shift in the neutrophils. Platelets were adequate and the red blood cells showed stomatocytes+, anisocytosis+ and target cells+. HbsAg was reactive while Anti HCV and HIV screening were non reactive
​
What is your diagnosis?
A. Multiple complicated perianal fistulae
B. Melanoma
​​​