A 42-Year-Old Man Comes to the Office Due to Increasing

A 42-year-old man comes to the office due to increasing anal pain.  Three days ago, he noticed mild anal discomfort when wiping after a bowel movement; since then, the pain has steadily increased and is now constant and severe.  The patient has had no anal drainage, hematochezia, or melena.  Medical history includes hypertension and type 2 diabetes mellitus.  There is no family history of colon cancer.  Temperature is 38.3 C (100.9 F) , blood pressure is 122/74 mm Hg, and pulse is 90/min.  Examination shows an erythematous, tender, 2-cm mass external to the anal verge on the right.  Digital rectal examination is normal, and stool guaiac testing is negative.  Incision and drainage are performed under local anesthesia, yielding approximately 5 mL of purulent fluid.  Which of the following is the best next step in management of this patient?

A) Colonoscopy
B) CT scan of the abdomen and pelvis
C) No further management indicated
D) Oral prednisone therapy
E) Systemic antibiotic therapy

Correct Answer:

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