Acute perianal streptococcal infection in an adult

Sir, Perianal infection or cellulitis caused by group A β‐haemolytic streptococci was originally described by Amren et al. in 1966.1 It is characterized by a superficial perianal well‐demarcated area of erythema without satellite lesions. Symptoms include perianal pruritus, painful defaecation, constipation and rectal bleeding, usually without fever or other systemic features. We describe a case of acute perianal streptococcal infection occurring in an adult. A 53‐year‐old man presented with a 2‐day history of sudden onset of severe irritation and pruritus affecting the perianal region. The patient had no history of eczema, did not use any topical preparations and was not taking any oral medication. On examination, his perianal region was acutely inflamed and a clinical diagnosis of perianal streptococcal infection was made. The patient was treated with oral penicillin V and flucloxacillin (500 mg four times a day for 1 week for both) together with Trimovate® (clobetasone butyrate, oxytetracycline and nystatin) cream topically twice a day to the affected area. This resulted in a rapid resolution of his symptoms without relapse. A heavy growth of group A β‐haemolytic streptococcus was isolated from a perianal swab.