Case history
Case history #1
A 21-year-old man presents to an urgent care clinic for pain adjacent to his natal cleft. The patient reports he initially noted a small bump a few days ago that has increased in size and has become more painful. He has had low grade temperatures. Exam reveals cellulitis in the natal cleft and a tender, fluctuant mass near the top of the natal cleft immediately to the right of the midline.
Case history #2
A 20-year-old man reports chronic offensive discharge of pus and blood from his natal cleft. He relates that several months previously he had a "boil" in the same region, which was painful and then burst spontaneously. On examination the patient has dense body hair. There are several sinus tracts in the midline or just lateral to the natal cleft, from which offensive-smelling discharge can be expressed.
Other presentations
Asymptomatic pilonidal disease may present as a single midline pit in the gluteal cleft, without associated tenderness, erythema, induration, fluctuance, or drainage.
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