723 PERIANAL STREPTOCOCCAL CELLULITIS

Abstract

Group A beta hemolytic streptococci can cause perianal cellulitis. First described by Amrert et al, (AJDC 112:546, 1966), this infection receives little attention in subsequent literature. This study describes 14 patients with perianal streptococcal cellulitis evaluated from 1975 to 1984. Characteristically, the infection caused painful defecation and constipation with an intensely erythematous, well-demarcated perianal rash and blood-streaked stools. The average age of patients was 3.9 years (range 1-10 yrs.); the male:female ratio was 3.7:1. Seven of the 14 children had rectal bleeding, 5 had anal fissures, 6 had constipation. The mean duration of symptoms before diagnosis was 6.2 months (range 1-12 months). Often, previous evaluation included multiple diagnostic tests and local therapies. Mis-diagnoses included simple anal fissure, inflammatory bowel disease, psychogenic stool holding, psoriasis and moniliasis. We established the diagnosis in all patients by culture of affected perianal skin and plating on 5% sheep-blood agar plates. Treatment with oral penicillin resulted in rapid resolution of the rash and disappearance of all complaints. Recrudescence of infection was not uncommon, necessitating a repeat course of oral antibiotics. On followup examination no patient had underlying gastrointestinal or systemic disease.