Perianal Nodule in Young Adult Female
Case at a Glance
An 18-year-old female presents with acute onset of a painful perianal mass discovered during routine hygiene.
Patient's Story
The patient is an 18-year-old female with no significant medical history, non-smoker, and not currently taking any medications. She reports discovering a painful, swollen bump on the perianal area during routine bathing. The patient initially attributed discomfort to recent bowel movement strain but became concerned upon palpating the lesion. She describes the mass as soft to firm in consistency, located externally rather than protruding from within the anal canal. The lesion causes discomfort primarily with direct pressure or anal sphincter contraction, but does not interfere with sitting. Symptoms developed acutely within hours of discovery.
Initial Assessment
Patient presents with acute perianal mass. Physical examination would be required to differentiate between common perianal conditions including thrombosed external hemorrhoid, perianal abscess, sebaceous cyst, or folliculitis.
The Diagnostic Journey
Given the acute onset, external location, and pain characteristics, differential diagnosis includes thrombosed external hemorrhoid, perianal abscess in early stages, infected sebaceous cyst, or acute folliculitis. The soft-firm consistency and external location help narrow the differential.
Final Diagnosis
Clinical diagnosis pending physical examination - most likely thrombosed external hemorrhoid or early perianal abscess based on presentation.
Treatment Plan
Patient advised to seek evaluation by primary care physician or urgent care for definitive diagnosis through physical examination. Conservative management with warm sitz baths, topical analgesics, and monitoring for progression may be appropriate pending clinical assessment.
Outcome and Follow-up
Patient counseled on need for medical evaluation for proper diagnosis and treatment plan. Follow-up recommended if symptoms worsen, fail to improve, or if systemic symptoms develop.