A 45-year-old man presents to the ED complaining of intense pain in his scrotum. For the past seven months, he has been developing small “boils” in the skin of the scrotum. He usually takes care of these at home with warm compresses or on occasion incises them with a straight razor blade.
He has drained them at home three times in the past seven months. During the past two days, he started to develop swelling, drainage, and extreme pain in the scrotum. His past medical history is significant for diabetes mellitus type 2.
He is uncomfortable but not toxic appearing. Vital signs are normal. His physical exam is notable for a diffusely tender, swollen, erythematous scrotum. Also noted is an opening that is draining copious purulent material as seen in the photograph.
What is your diagnosis? See p. 36.