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Pyoderma fistulans sinifica (fox den disease): a distinctive soft-tissue infection
D H Wittmann1, M Schein, D Seoane
1Department of Surgery, Medical College of Wisconsin, Milwaukee 53226, USA.
Summary
Pyoderma fistulans sinifica (PFS) is a chronic infectious disease forming epithelialized tracts. Wide surgical excision is the most effective treatment, as antibiotics alone do not eradicate the infection.
Area of Science:
- Dermatology
- Infectious Diseases
- Surgical Pathology
Background:
- Pyoderma fistulans sinifica (PFS), or fox den disease, is a distinct chronic infectious condition characterized by subdermal epithelialized tracts.
- PFS requires differentiation from similar conditions like hidradenitis suppurativa, pilonidal sinus, and perianal fistula.
- This condition has not been previously detailed in English-language medical literature.
Observation:
- A study reported on 10 male patients with PFS, with a mean age of 36 years and a mean disease duration of 11 years.
- Bacterial cultures from affected tissues revealed a polymicrobial flora, including 14 facultative and 31 obligate anaerobic species.
- The fistulous tracts in PFS are lined by stratified squamous-cell epithelium and extend deep into subcutaneous fat, separate from skin appendages.
Findings:
- Wide en-bloc excision down to the fascia, encompassing all fistulae, was the primary treatment modality.
- Antibiotic therapy provided temporary relief from purulent discharge but failed to achieve infection eradication.
- Recurrences were observed in two patients who underwent fistulotomy without complete surgical excision.
Implications:
- Surgical intervention, specifically wide en-bloc excision, appears crucial for the effective management of Pyoderma fistulans sinifica.
- The findings highlight the limitations of antibiotic therapy in eradicating PFS infections.
- Accurate differentiation and surgical planning are essential for successful treatment outcomes in PFS.