Patient information: the patient is 22 years old male with no medical history, non-smoking, obese with a BMI of 31 kg/m2 with no history of a tuberculosis contamination.
Clinical findings: he consults for a right axillary suppuration evolving for two years with repeated episodes of abscessing, fistulization, and purulent flow. The initial lesion seemed to be an inflammatory induration of 2.5 cm, evolving by a push towards an extension on the surface and adherence to the deep plane. The evolution of the case was marked by periods of clinical improvement with the sagging of the renitent masses but then reappearing a few months later. This disabling situation altered the patient's quality of life and led him to many consultations during the last few years with protocols combining local care, antibiotics, and even repeated drainage of the collections. The examination at the admission finds an endure cupboard at the level of the right axillary region. It is 5cm in diameter with many fistulas and umbilicated papules adhering to the deep plane with ipsilateral lymphadenopathy (Figure 1). The rest of the skin examination spotlights lesions of predominant folliculitis at the back, the trunk, and acne on the face (Figure 2). Besides, the patient does not display any general infectious signs (no fever or chills, or night sweats).
Therapeutic interventions: we have opted for surgical exploration for diagnostic and therapeutic purposes. A wide surgical excision was performed in one piece, carrying the entire fistulized skin flap to the surface with its deep extensions and adhering lymphadenopathy to the magma of the inflammatory tissue (Figure 3). We maintained post-surgery drain care for 48 hours, a probabilistic antibiotic therapy approach, and local care until healing. The specimen has been oriented and sent for pathological examination.
Diagnostic assessment: histological analysis reveals the following: inflammatory lymphadenitis with caseous necrosis. Absence of signs of malignancy (Figure 4). The patient received treatment based on anti-tuberculosis therapy.
Follow-up and outcome of interventions: the postoperative evolution was good, with complete healing after a week and no recurrence (Figure 5).
Patient perspective: the patient was satisfied with the treatment and the postoperative results.
Informed consent: the patient provided full consent after an oral explanation of our intention of publishing her case.