Pyoderma Fistulans Sinifica (Fox Den Disease): A Distinctive Soft-Tissue Infection

• Published in: Clinical infectious diseases Vol. 21; no. 1; pp. 162 - 170
• Main Authors: Wittmann, Dietmar H., Schein, Moshe, Seoane, Debra, Aprahamian, Charles, Komorowski, Richard A., Georgakas, Kristina, Quebbeman, Edward J., Wallace, James R., Condon, Robert E.
• Format: Journal Article
• Language: English
• Published: Chicago, IL The University of Chicago Press 01-07-1995; University of Chicago Press
• Subjects: Abscess - microbiology; Abscess - pathology; Abscess - surgery; Adult; Bacteria, Anaerobic - isolation & purification; Bacterial diseases; Bacterial diseases of the skin; Bacterial Infections - microbiology; Bacterial Infections - pathology; Bacterial Infections - surgery; Biological and medical sciences; Buttocks; Clinical Articles; Cutaneous Fistula - microbiology; Cutaneous Fistula - pathology; Cutaneous Fistula - surgery; Epithelium; Fistulas; Foxes; Hidradenitis suppurativa; Hidradenitis Suppurativa - microbiology; Hidradenitis Suppurativa - pathology; Hidradenitis Suppurativa - surgery; Histology; Human bacterial diseases; Humans; Infectious diseases; Male; Medical sciences; Middle Aged; Pilonidal sinuses; Pyoderma; Pyoderma - microbiology; Pyoderma - pathology; Pyoderma - surgery; Recurrence; Reoperation; Skin; Skin - pathology; Skin diseases; Soft Tissue Infections - microbiology; Soft Tissue Infections - pathology; Soft Tissue Infections - surgery; Infection; Case study; Human; Skin disease; Pyoderma; Bacteriosis; Soft tissue
• ISSN: 1058-4838; 1537-6591
• DOI: 10.1093/clinids/21.1.162

Pyoderma fistulans sinifica (PFS, also referred to as fox den disease because its multiple fistulae and sinuses resemble the structure of a fox den) is a distinct chronic infectious disease in which epithelialized tracts form within the subdermal fatty tissue. PFS, which has not been previously described in the English-language literature, must be differentiated from hidradenitis suppurativa, pilonidal sinus, and perianal fistula. The fistulous tracts of PFS are always lined by stratified squamous-cell epithelium but, unlike those of hidradenitis, reach deep into the subcutaneous fat, run epifascially for long distances, and have no relation to skin appendices. We report on 10 men (mean age ± SD, 36 ± 5 years) with PFS (mean duration ± SD, 11 ± 7 years). Bacterial cultures of affected tissue from these patients yielded a total of 14 facultative and 31 obligate anaerobic species. Treatment consisted of wide en-bloc excision down to the fascia, including all fistulae. Antibiotic therapy temporarily reduced purulent discharge but did not eradicate the infection. Two patients who underwent fistulotomy without wide en-bloc excision developed recurrences.