Bacterial perianal dermatitis caused by Enterococcus faecalis with intrafamily spread: Report of a rare case

Abstract

Bacterial perianal dermatitis is a childhood disorder, most commonly caused by the beta-hemolytic group A streptococcus. Despite being well-recognized in the literature, this condition is often not recognized by healthcare practitioners, leading to a delay in the proper diagnosis and treatment. An 8-year-old boy presented with a three-week history of perianal itching, constipation and blood-streaked stools. Clinical examination revealed a bright red, sharply demarcated rash that extended approximately 3 cm circumferentially around the anus. Positive cultures for Enterococcus faecalis from the perianal area and the stools confirmed the diagnosis of perianal dermatitis caused by an uncommon microorganism. Therapy with systematic oral cefuroxime and topical mupirocin cream led to a resolution of the symptoms and the itchy rash by day 4. 2 weeks after the onset of symptoms in the patient, his 10-year-old brother developed perianal itching and mucous discharge. Stool cultures again identified E. faecalis and the same treatment methods were applied, resulting in rapid resolution of the symptoms. Perianal dermatitis should be included in the differential diagnosis when a child aged from 6 months to 10 years old complains of perianal symptomatology. The differential diagnosis is wide and includes candidiasis, psoriasis, inflammatory bowel disease, diaper dermatitis, parasite infections and sexual abuse. The diagnosis is confirmed with culture swabs of the affected area and treatment should be guided based on the culture and antibiotic sensitivity testing.

Keywords

Childhood - Enterococcus faecalis - enterococcal infections - perianal dermatitis - perianal rash