A unique pneumopathy in a patient with skin nodules and abscesses

Excerpt

A 34-year-old man was referred to the Department of Dermatology of our hospital because of a presumed diagnosis of perianal Crohn’s disease. Medical history was positive for severe acne, while there was no positive family history for either inflammatory bowel diseases or allergies. On physical examination, the patient was apyretic, with a blood pressure of 132/86 mmHg, heart rate of 76 beats/min, 17 breaths/min, 97% oxygen saturation in room air. He reported a mild dyspnea occurred 1 month before, with Valleix points examination negative; however, auscultation revealed some crackles prevalently in the bases. Dermatological assessment showed multiple deep-seated inflamed nodules, fistulas and bridging scars on armpits and perianal area with scrotal involvement (Fig. 1). Laboratory investigations demonstrated an increased erythrocyte sedimentation rate (76 mm/h; range 20–50 mm/h); C-reactive protein was also elevated (18 mg/L; range 0.2–5 mg/L). Urine examination, procalcitonine and quantiferon-tests were negative. Therapy was initially azithromycin 500 mg daily for 3 consecutive days weekly for 6 weeks. At the same time, the dyspnea was also evaluated.

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