Perianal infectious dermatitis: An underdiagnosed, unremitting and stubborn condition

Table 3 Case reports with perianal infectious dermatitis: Clinical and bacteriological patient characteristics

Name, yr, country	Case age, sex	Symptoms/signs1; symptom duration	Etiology of PID	Other findings2
Hirschfeld, 1970, United States[59]	1-2. 6 yr, F and 3 yr brother	1-2. Painful defecation; several days	GAS (culture)	1-2. Both had sore throats 2 wk prior
	3-4. 5 yr and 3 yr brothers (unrelated family)	3-4. Same history and symptoms		3-4. Throat GAS positive (1 case)
Farmer, 1987, United Kingdom[65]	1. 4 yr, M	1. White anal discharge, perianal pustules; 3 wk	GAS (culture)
	2. 5 yr, F	2. Perianal itching, pain on defecation, dysuria; vulva affected; 3 wk
Rehder, 1998, United States[61]	1. 3 yr, M	1. Rectal irritation; 6 mo	GAS (culture)	1. Sibling, 6 yr: GAS pharyngitis recently
	2. 3 yr, M	2. Perianal pain and itching; 5 wk		2. Patient: throat GAS positive; sibling with recent sore throat
	3. 4 yr, M	3. Perirectal pain; 6 wk		3. Identical GAS from anus and throat
	4. 1 yr, F	4. GP; 3 wk
Honig, 1988, United States[62]	4; 15 mo, 6, 8 and 12 yr; 3 M	Anal pruritus, bloody anal discharge; GP: 2 cases, appeared 9 mo after onset of PID; 1 M with PID history of 2 yr	GAS (culture)
Marks, 1988, United States[63]	5 yr, M	Perianal irritation and pruritus, bloody discharge; 2 wk	GAS (culture)
Guerrero - Vázquez 1989, Spain[64]	2 cases	Perianal irritation in both; seropurulent anal and balano-preputial discharge in 1 case	GAS (culture)
Duhra, 1990, United Kingdom[29]	5 yr, M	Painful defecation, micturition, bloody stool; penile erythema swelling; 4 wk	GAS (culture)	GAS positive from penile skin; members of patient's family: severe sore throat recently
Goodyear, 1991, United Kingdom[30]	4 yr, M	Painful defecation, blood-streaked liquid stool; fecal incontinence; 6 wk	GAS (culture)
Medina, 1992, Spain,[31]	4 yr, M	Perianal pruritus and bleeding; 3 mo	GAS (culture)
Montemarano, 1993, United States[32]	3 yr, M	Painful perianal area, satellite pustules; 2 mo	S. aureus (culture)	S. aureus positive in anterior nares and satellite pustule
Guppy, 1993, Australia[33]	1. 7 yr, M	1. Perianal excoriation; 8 wk	GAS (culture)	The three siblings bathing together
	2-3. His 2 brothers, 5 and 2.5 yr	2-3. Similar history
	4. 4 yr, M	4. Typical PID; penis lesions later; 4 wk
Paradisi, 1993, Italy[34]	3 yr, M	Perianal itching; 2 mo	GAS (culture)
Paradisi, 1994, Italy[35]	1. 3 yr, F 2. 5 ½ yr, M, brother	Painful defecation, perianal itching, rectal bleeding, constipation	GAS
van Zeijl, 1996, Netherlands[36]	4; 3 M (1, 6 and 8 yr, the last 2 brothers); 1 F (2 yr)	Constipation, painful defecation, diarrhea	GAS (culture)	Brothers shared same toilet
Saxen, 1997, Finland[37]	1. 3 yr, M	1. Itchy anus and bloody stool; 1 w	GAS (T28)
	2-3. Other cases	2. Same symptoms		2. Throat GAS positive, identical (T28)
Berlin, 1997, United States[38]	3 yr, M	Constipation, myositis	GAS (culture)	His mother had sore throat GAS positive
Bugatti, 1998, Italy[39]	12 yr, M	Perianal discharge, 1 mo	GAS (culture)
Adams, 1999, Canada[40]	1 yr, M	Typical PID	GAS (culture)
Roos, 1999, Sweden[41]	5 yr, M	Anal pruritus	GAS T28 (culture)	Case: throat GAS negative; mother: GAS tonsillitis positive; anal and throat GAS identical
Velez, 1999, Spain[42]	2 yr, M	Fever 39-40 °C, erythema: perianal, genitalia and proximal thighs	GAS (culture)	Throat negative
Herbst, 2000, Germany[9]	4 yr, M	GP; 6 w history; PID discovered at physical exam	GAS (culture)	Patient and family members: Negative GAS throat
Brilliant, 2000, United States[43]	1. 4 yr, M	1. Rectal itching and pain, scant mucoid discharge	GAS (RADT + culture)
	2-3. 2 mo and 30 mo	2-3. Several days later with similar symptoms		2-3. Siblings of case 1
	4. 4 yr, F	4. Plus vulvitis		4. Neighbor of the 3 cases
Balasubramanian, 2000, India[44]	1. 13 mo, M	1. Fever, painful defecation, anal pruritus; 2 d	GAS (culture)
	2. 11 mo, M	2-3. Fever, painful defecation
	3. 13 mo, F
Heidelberger, Germany, 2000[45]	1. 6 yr, M	1. Anal itching and burning; 3 mo	GAS (culture)
	2. 9 yr, M	2. Balanitis and impetigo
Nowicki, 2000, United States[46]	7 yr, M	Perianal itching, painful defecation; 10 d	GAS (culture)	Throat GAS negative
Soulliet, 2000, France[13]	7 yr, F	Vulvar erythema, perirectal pain, painful defecation, constipation; perioral impetigo; 3 wk	GAS (culture)	Perioral GAS positive
Lunghi, 2001, Italy[47]	Brother (4 yr) and sister (6 yr)	1 also vulvo-vaginitis; 4 mo	GAS (culture)	Throat GAS positive in both patients
Romano, 2002, Italy[48]	12 yr, M	PID and GP	GAS
Huang, 2003, Taiwan[49]	6 yr, M	Perianal itching, painful defecation, scant mucoid discharge	GAS (culture)	Throat GAS positive
Reimer, 2004, Sweden[50]	1. 4 yr, M	1. Perianal discomfort	1. GAS (RADT)
	2. 6 yr, M	2. Purulent discharge plus balanitis	2. GAS	2. Penis culture GAS positive; father treated for GAS pharyngitis; brother, 4 yr with GAS PID and brother 2 yr with GAS pharyngitis
	3. 4 yr, F	3. Perianal pain, vulvar erythema and pain	3. GAS
Takeshita, 2006, Japan[51]	1. 2 yr, F	1. PID; 2 wk	GAS (culture)
	2. 6 mo, M	2. PID; 1 wk
Usuki, 2006, Japan[52]	5 yr, F	PID	GAS (RADT)	4 d later: Father with symptoms of PID and GAS positive
Ulger, 2007, Turkey[53]	3 yr, M	Pain on defecation, anal pruritus; 8 d; GP: 2 d	GAS (culture)	Sore throat 2 wk before; no culture, no therapy needed
Greisser, 2008, Swiss[54]	7 yr, M	Perianal pain and pruritus, yellow discharge; 3 d	GAS (RADT + culture)	Throat GAS negative
Lehman, 2009, United Kingdom[7]	3 yr, F	Itchy bottom and painful defecation; 2 wk	GAS (culture)
Ledoux, 2009, France[55]	4 yr, M	PID for 2 wk; lesions of GP since second week	GAS (culture)
Rasi, 2009, Iran[56]	4 yr, M	Rectal itching and burning, pain on defecation; plaque type psoriasis; 3 mo	GAS (RADT)
Block, 2013, United States[57]	1. 2 mo, F	1. PID and vulvar erythema	GAS	1. 8 yr sibling: previous GAS pharyngitis
	2. 4 mo, F	2. Blood in diaper
Theotokatou, 2014, Greece[58]	1. 8 yr, M	1. Perianal itching, constipation, blood-streaked stool; 3 wk	Enterococcus faecalis (culture) in both)
	2. 10 yr, M, brother	2. Perianal itching and mucous discharge (2 wk after onset of symptoms of his brother)
Zhang 2016, Canada[3]	1. 4 yr, M	1. Painful defecation, GP, penile erythema	1. GAS and S. aureus	1. Throat GAS positive
	2. 4 yr, M	2. Painful defecation, GP	2. GBS	2. Throat culture negative
	3. 3 yr, F	3. Perivulvar erythema, small amount of greenish-yellowish vaginal discharge	3. GCS	3. Throat culture negative; vulvar culture few GCS and scant S. aureus
Garritsen, 2017, Netherlands[60]	19 mo, M	PID and 1 wk later: GP	GAS
Serban, present study, Romania	1. 9 yr 4 mo, M	1. Perianal pain and pruritus, anal mucous and bloody discharge, painful defecation; 6 wk	1. GBS and S. aureus (culture)	1. Throat GAS, GBS and S. aureus negative
	2. 9 yr 6 mo, M	2. Anal pruritus, painful defecation, anal mucous and bloody discharge	2. GAS (culture)	2. Throat GAS positive
	3. 11 yr 9 mo, M	3. Anal pruritus, mucous and bloody discharge, painful defecation, constipation	3. GAS (culture)	3. Throat GAS negative

¹Besides typical perianal erythema;

²Especially throat culture and infections in the family/community. F: Female; GAS: Group A beta-hemolytic streptococci; GBS: Group B beta-hemolytic streptococci; GCS: Group C beta-hemolytic streptococci; GP: Guttate psoriasis; M: Male; PID: Perianal infectious dermatitis; RADT: Rapid antigen detection test; S. aureus: Staphylococcus aureus; T28: T-type 28 of GAS.