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Reina J, Iturbe A. [Detection of Epstein-Barr virus in female genital ulcers]. Rev Esp Quimioter 2024:reina21may2024. [PMID: 38770625 DOI: 10.37201/req/005.2024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2024]
Affiliation(s)
- J Reina
- Jordi Reina,Unidad de Virología. Servicio de Microbiología. Hospital Universitario Son Espases. Carretera de Vallmedossa 79. 07120 Palma de Mallorca. Spain.
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2
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Brambilla I, Bolcato V, Volonté M, Querzani A, Guarracino C, Tondina E, Marseglia GL, Brazzelli V. Lipschütz ulcers due to SARS-CoV-2 infection: a neglected diagnosis in emergency room. Int J Womens Dermatol 2024; 10:e122. [PMID: 38348354 PMCID: PMC10861013 DOI: 10.1097/jw9.0000000000000122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2023] [Accepted: 10/23/2023] [Indexed: 02/15/2024] Open
Abstract
Background Primary acute genital ulcers, or Lipschütz ulcers (LU), are nonsexually transmitted, painful, self-limiting, nonrecurrent vulvar ulcers with unclear pathogenesis, representing a challenging diagnosis in emergency setting. LU have recently been described in association with severe acute respiratory syndrome coronaVirus 2 (SARS-CoV-2) infection and vaccination. Objective The aim of this study is to describe 2 cases of LU due to SARS-CoV-2 infection, highlighting the diagnostic process, differential diagnosis, disease course, and management options. Methods We describe 2 young females (12 and 9 years old) who presented to pediatric emergency room with the sudden onset of well-demarcated, painful, vulvar ulcers with fibrinous necrotic center. Results Both patients tested positive to SARS-CoV-2 nasal swab, and, at physical examination, no other lesions were found in other cutaneous or mucosal sites. Sexual abuse was excluded in both cases, as well as infectious and autoimmune diseases. Supportive analgesic therapy was administered, and complete remission of lesions was observed at follow-up visits without evidence of scarring. Limitations The main limitation of this work is represented by the small number of cases described. Conclusion Even though extremely rare, LU related to COVID-19 are an emerging entity to be considered in the diagnosis of acute genital ulcerations. Multidisciplinary diagnostic workup of genital ulcers must be established in order to exclude sexual child abuse, to ensure patient safety, and to avoid unnecessary treatment and familial anxiety.
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Affiliation(s)
- Ilaria Brambilla
- Department of Pediatrics, Pediatric Clinic, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Vittorio Bolcato
- Department of Public Health, Experimental and Forensic Medicine, Fondazione Istituto Neurologico Nazionale C. Mondino I.R.C.C.S., Unit of Legal Medicine, Pavia, Italy
| | - Martina Volonté
- Department of Clinical, Surgical and Pediatric Sciences, Institute of Dermatology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Andrea Querzani
- Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, Università degli Studi di Pavia, Pavia, Italy
| | - Carmen Guarracino
- Department of Pediatrics, Pediatric Clinic, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Enrico Tondina
- Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, Università degli Studi di Pavia, Pavia, Italy
| | - Gian Luigi Marseglia
- Department of Pediatrics, Pediatric Clinic, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
- Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, Università degli Studi di Pavia, Pavia, Italy
| | - Valeria Brazzelli
- Department of Clinical, Surgical and Pediatric Sciences, Institute of Dermatology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
- Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, Università degli Studi di Pavia, Pavia, Italy
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3
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Roy Chowdhury S. Genital Ulcers Are Not Always Because of Sexually Transmitted Infections: A Case Report of an Unusual Presentation of Fixed Drug Eruption in a Pediatric Patient. J Pediatr Health Care 2024:S0891-5245(23)00375-9. [PMID: 38260927 DOI: 10.1016/j.pedhc.2023.12.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Revised: 12/20/2023] [Accepted: 12/22/2023] [Indexed: 01/24/2024]
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Mahaju S, Achhami E, Lamichhane S, Chalise KN, Gautam R. A rare case of Behcet's disease in Nepal: multisystem manifestations and diagnostic challenges. Ann Med Surg (Lond) 2023; 85:5259-5262. [PMID: 37811046 PMCID: PMC10553148 DOI: 10.1097/ms9.0000000000001279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Accepted: 08/26/2023] [Indexed: 10/10/2023] Open
Abstract
Behcet's disease (BD) is a chronic inflammatory disorder characterized by a relapsing and remitting course and multisystem involvement. The authors present a case report of a 20-year-old male who presented with bilateral knee joint pain, oral and genital ulcers, and papulopustular skin lesions. The patient's clinical history, physical examination, laboratory findings, and biopsy results were consistent with the diagnosis of BD. The patient tested positive for the HLA-B51 allele, confirming a genetic predisposition. The diagnosis was supported by a positive pathergy test and a skin biopsy showing vasculitis. The diagnostic criteria established by the international study group and the International Criteria for Behcet's Disease were fulfilled. Treatment consisted of colchicine, azathioprine, and topical corticosteroids. This case highlights the importance of recognizing the varied clinical presentations of BD and the need for a multidisciplinary approach to diagnosis and management. Early and accurate diagnosis is crucial to prevent severe complications and improve patient outcomes.
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Affiliation(s)
| | - Eliz Achhami
- Sukraraj Tropical and Infectious Disease Hospital
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5
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Mushtaq MH, Ali Khan O, Khan H, Ikram MT, Tariq MD. Inferior Vena Cava Thrombosis and Pulmonary Embolism in a Patient With Behcet Disease: A Rare Presentation. Cureus 2023; 15:e44184. [PMID: 37767251 PMCID: PMC10520997 DOI: 10.7759/cureus.44184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/26/2023] [Indexed: 09/29/2023] Open
Abstract
Behcet syndrome is a systemic vasculitic syndrome. Vascular involvement in Behcet syndrome affects both arterial and venous vascular systems, contributing to significant morbidity and mortality. However, diagnosing vascular lesions can be challenging due to their resemblance to common vascular diseases, leading to potential misdiagnoses. This case report emphasizes the importance of recognizing atypical manifestations of this disease to ensure a prompt and accurate diagnosis. This case report describes a unique presentation of Behcet syndrome in a 23-year-old male patient who presented with per rectal bleeding, abdominal distension, right quadrant abdominal pain, pleuritic chest pain, and fever. The patient also reported a history of recurrent oral and genital ulcers, skin lesions, and a previous episode of dural venous sinus thrombosis. Extensive investigations revealed the involvement of the inferior vena cava and right hepatic vein, representing an atypical vascular manifestation of Behcet syndrome. Prompt diagnosis by a multidisciplinary team led to appropriate treatment with cyclophosphamide and steroids, resulting in the resolution of vascular thrombosis. In this particular case, the patient presented with involvement of the inferior vena cava and right hepatic vein, a rare and unusual manifestation of the disease. This case highlights the diverse nature of vascular complications in Behcet syndrome and underscores the importance of considering this diagnosis in patients with unexplained vascular abnormalities. Overall, this case report highlights the importance of considering Behcet syndrome in the differential diagnosis of patients with unexplained vascular manifestations. It also emphasizes the need for a comprehensive clinical evaluation and collaborative approach to ensure timely and effective management.
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Affiliation(s)
| | - Osama Ali Khan
- Internal Medicine, Khyber Teaching Hospital, Peshawar, PAK
| | - Hasnat Khan
- Internal Medicine, Lady Reading Hospital, Peshawar, PAK
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6
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Kudsi M, Drie T, Haidar G, Al-Sayed S, Roumieh E. Genital Ulcers Associated with Systemic Lupus Erythematosus - What are the Possible Causes? A Case Report. Eur J Case Rep Intern Med 2023; 10:003972. [PMID: 37554473 PMCID: PMC10405874 DOI: 10.12890/2023_003972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 06/21/2023] [Indexed: 08/10/2023] Open
Abstract
UNLABELLED Systemic lupus erythematosus (SLE) is a chronic systemic autoimmune disease that affects many organs. In this report, we discuss the case of a patient with SLE who presented to an out-hospital clinic, complaining of fever and pain with genital ulcers. Negative evaluations for other causes of genital ulcers, indicated these ulcers as related to SLE. This case highlights the importance of including SLE ulcers in the differential diagnosis of genital ulcers. LEARNING POINTS Determining the cause of genital ulceration is a clinical challenge, especially in sexually active individuals.Genital ulcers associated with SLE are often underdiagnosed. Any patient with a history of SLE presenting with genital discomfort and/or pain must be evaluated for genital ulcers without delay.
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Affiliation(s)
- Maysoun Kudsi
- Rheumatology Department, Faculty of Medicine, Damascus university / Syrian Private University, Damascus, Syria
| | - Tasneem Drie
- Rheumatology Department, Faculty of Medicine, Damascus university / Syrian Private University, Damascus, Syria
| | - Ghina Haidar
- Rheumatology Department, Faculty of Medicine, Damascus university / Syrian Private University, Damascus, Syria
| | - Safaa Al-Sayed
- Rheumatology Department, Faculty of Medicine, Damascus university / Syrian Private University, Damascus, Syria
| | - Enas Roumieh
- Rheumatology Department, Faculty of Medicine, Damascus university / Syrian Private University, Damascus, Syria
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Deoghare S, Gupta S, Pol D, Masare A, Kumar A. Recurrent Genital Herpes Triggering Ulcerative Pyoderma Gangrenosum. Cureus 2023; 15:e40953. [PMID: 37503492 PMCID: PMC10368958 DOI: 10.7759/cureus.40953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/19/2023] [Indexed: 07/29/2023] Open
Abstract
Pyoderma gangrenosum (PG) is a neutrophilic dermatosis that presents as painful, rapidly growing skin ulcers with undermined edges and a violaceous, ragged border at the periphery and is non-responsive to conventional treatments. The average onset age is in the fourth decade, with a female preponderance. Genital PG is uncommon and may present singly or coexist with common sexually transmitted genital ulcerative diseases, which causes delays in the diagnosis and treatment of genital PG, thereby adding to the morbidity. Here, we highlight a case of non-healing genital ulcers that did not respond to conventional antibiotic treatment and aggravated each month with menstruation. In this case, menstruation acted as a trigger factor for the development of a herpes genital infection. The latter acts as a pathergy for the monthly aggravation of genital PG. The patient responded to treatment with anti-viral medications and immunosuppressive medications.
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Affiliation(s)
- Shreya Deoghare
- Department of Dermatology, Venereology, and Leprosy, Dr. D. Y. Patil Medical College Hospital and Research Centre, Dr. D. Y. Patil Vidyapeeth, Pune, IND
| | - Shailya Gupta
- Department of Dermatology, Venereology, and Leprosy, Dr. D. Y. Patil Medical College Hospital and Research Centre, Dr. D. Y. Patil Vidyapeeth, Pune, IND
| | - Devayani Pol
- Department of Dermatology, Venereology, and Leprosy, Dr. D. Y. Patil Medical College Hospital and Research Centre, Dr. D. Y. Patil Vidyapeeth, Pune, IND
| | - Anuja Masare
- Department of Dermatology, Venereology, and Leprosy, Dr. D. Y. Patil Medical College Hospital and Research Centre, Dr. D. Y. Patil Vidyapeeth, Pune, IND
| | - Ajay Kumar
- Department of Dermatology, Venereology, and Leprosy, Dr. D. Y. Patil Medical College Hospital and Research Centre, Dr. D. Y. Patil Vidyapeeth, Pune, IND
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8
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Gay C, Kihara C, Haley A, Patel AN, Stolzenberg L, Haviland E, Shassberger S. Lipschütz Ulcers: Classic Presentation of an Uncommon Condition. Cureus 2023; 15:e38505. [PMID: 37273409 PMCID: PMC10238287 DOI: 10.7759/cureus.38505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2023] [Accepted: 05/03/2023] [Indexed: 06/06/2023] Open
Abstract
We describe the case of a 17-year-old female who presented with the acute onset of painful genital ulcers after experiencing a week of flu-like symptoms. A physical exam revealed two 1 cm necrotic ulcers on the right vulva with an erythematous margin and overlying exudate. A diagnosis of Lipschütz ulcers was made based on the classic signs and symptoms, in addition to ruling out relevant infectious and inflammatory diseases. Our goal in presenting this case is to add to the literature and increase awareness regarding this uncommon condition. The differential diagnosis and workup for genital ulcers can be extensive, but when diagnosed correctly, treatment and reassurance can provide great comfort for the patient.
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Affiliation(s)
- Carter Gay
- Research, Alabama College of Osteopathic Medicine, Dothan, USA
| | - Colby Kihara
- Research, Alabama College of Osteopathic Medicine, Dothan, USA
| | - Austin Haley
- Research, Alabama College of Osteopathic Medicine, Dothan, USA
| | - Arsh N Patel
- Research, Alabama College of Osteopathic Medicine, Dothan, USA
| | | | - Erika Haviland
- Research, Alabama College of Osteopathic Medicine, Dothan, USA
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Brundu M, Marinello S, Scaglione V, Ferrari A, Franchin E, Mazzitelli M, Cattelan AM. The first case of monkeypox virus and acute HIV infection: Should we consider monkeypox a new possible sexually transmitted infection? J Dermatol 2023; 50:383-386. [PMID: 35996211 DOI: 10.1111/1346-8138.16556] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Revised: 07/27/2022] [Accepted: 08/08/2022] [Indexed: 11/28/2022]
Abstract
Since May 2022, a Monkeypox virus (MPXV) outbreak has been ongoing in several non-endemic countries. MPXV is usually transmitted after intimate contact, through body fluids, close contact from active lesions or through respiratory droplets. The recent outbreak occurrent in people with multiple recent sexual intercourse suggests the sexual route as the main way of transmission. However, there is no sufficient evidence to consider MPXV as a new sexually transmitted infection (STI), even though we believe that a link between MPXV and other STIs may exist with a possible facilitating action on their spreading. Herein, we illustrate the first case described during the current outbreak of a young man with both MPXV and acute HIV infection in a non-endemic country.
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Affiliation(s)
- Monica Brundu
- Infectious and Tropical Diseases Unit, Padua University Hospital, Padua, Italy
| | - Serena Marinello
- Infectious and Tropical Diseases Unit, Padua University Hospital, Padua, Italy
| | - Vincenzo Scaglione
- Infectious and Tropical Diseases Unit, Padua University Hospital, Padua, Italy
| | - Anna Ferrari
- Infectious and Tropical Diseases Unit, Padua University Hospital, Padua, Italy
| | - Elisa Franchin
- Microbiology and Virology Unit, Padua University Hospital, Padua, Italy
| | - Maria Mazzitelli
- Infectious and Tropical Diseases Unit, Padua University Hospital, Padua, Italy
| | - Anna Maria Cattelan
- Infectious and Tropical Diseases Unit, Padua University Hospital, Padua, Italy
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10
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Saraswat N, Kumar S, Prem R, Tripathi DM. Genital ulcers following all-trans-retinoic acid therapy: A case series with review of literature. Indian J Pharmacol 2023; 55:138-140. [PMID: 37313940 DOI: 10.4103/ijp.ijp_811_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/15/2023] Open
Abstract
All-trans-retinoic acid (ATRA) has transformed the treatment of acute promyelocytic leukemia. Most of the adverse effects associated with this drug are minor barring differentiation syndromes. Genital ulcers feature among the underreported adverse effects of ATRA which needs to be kept in mind to avoid life-threatening complications. We describe two cases who developed genital ulcers while treated with ATRA.
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Affiliation(s)
- Neerja Saraswat
- Department of Dermatology, Military Hospital Agra, Agra, Uttar Pradesh, India
| | - Sushil Kumar
- Department of Dermatology, Military Hospital Agra, Agra, Uttar Pradesh, India
| | - Rahul Prem
- Department of Internal Medicine, Military Hospital Agra, Agra, Uttar Pradesh, India
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Abstract
Behçet Disease is a relapsing and remitting variable vessel vasculitis characterized by recurrent mucocutaneous ulcers that can involve almost every organ system in the body. Indeed, the presence of recurrent oral or genital ulcers with other auto-inflammatory symptoms should raise suspicion for this elusive disease. It is unique among the vasculitides in that it can affect vessels of small, medium, and large size and tends to involve venous rather than arterial circulation, and its effects on the pulmonary venous circulation are particularly notable for their role in disease mortality. Classically seen in Mediterranean, Middle-Eastern, and eastern Asian countries, and relatively rare in the United States, prevalence has been increasing, prompting an increased need for internists to be aware of Behcet's clinical presentation and treatment. As early recognition and diagnosis of the disease is key to successful treatment and better prognosis, this review provides a brief summary of the current etiological theories, important clinical manifestations, and treatments including newer biologic alternatives.
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Affiliation(s)
- Daniel Pak
- Internal Medicine, St Mary Medical Center, Langhorne, Pennsylvania, USA
| | - Hyon Ju Park
- Internal Medicine, Lankenau Medical Center, Wynnewood, Pennsylvania, USA
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12
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Abstract
Background: Human monkeypox (HMPX) is currently spreading outside endemic countries in Africa and the majority of those affected are gay and bisexual men within interconnected sexual networks. We investigated the sexual history of HMPX cases seen at a tertiary hospital in Bayelsa State during the 2017-2018 outbreak in Nigeria.Method: A cross-sectional study was conducted between 20 October 2017 and 2 January 2019 among adult confirmed/probable HMPX cases. A questionnaire was used to collect data on the sexual history of participants, including sexual contact in relation to the first symptom, and high-risk behaviours (HRB) such as a history of condomless casual sex, multiple sexual partners, and transactional sex.Results: Of 21 patients, 16 (76.2%) gave consent to participate in the study: age range of 22-43 years, 75% males, three (18.8%) HIV-1 positive, and 13 (81.2%) with genital ulcers. Nine (56.2%) of participants reported HRB, and all were male heterosexuals. Eight of the 16 participants (50%) reported having sex within a month before their first symptom, and five (62.5%) of this number reported HRB. There were two cases of sex with a partner with a non-genital rash, and a spouse who developed a vulval ulcer four days after sex with her husband.Conclusion: Our results support the role of sexual contact in the transmission of monkeypox among some confirmed cases from Nigeria. However, future elaborate studies are required to confirm if sexual behaviour and sexual transmission are associated with HMPX in Nigeria.
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Affiliation(s)
- Dimie Ogoina
- Infectious Diseases Unit, Department of Internal Medicine, 146956Niger Delta University/Niger Delta University Teaching Hospital, Amassoma, Nigeria
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13
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Abstract
A 26-year-old woman under immunosuppression with infliximab due to Crohn's disease was referred to the gynaecology emergency room with dispersed and coalescing vesicular lesions on the vulvar region extending to the right lower limb involving S2-S3 dermatome, associated with severe pain. Clinical history, physical examination and serological testing was consistent with herpes zoster infection. The patient was treated with valaciclovir for 14 days and cefradine for 7 days (due to the possibility of secondary bacterial infection). Significant symptomatic improvement was noted after 1 week. The 1-year follow-up was unremarkable. According to our knowledge and review of the literature, this is one of the few cases reported of vulvar herpes zoster, especially related to infliximab.
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Affiliation(s)
- Matilde Matos Martins
- Gynaecology and Obstetrics, Centro Hospitalar de Entre o Douro e Vouga EPE, Santa Maria da Feira, Portugal
| | - Patrícia Ferreira
- Gynaecology and Obstetrics, Centro Hospitalar de Entre o Douro e Vouga EPE, Santa Maria da Feira, Portugal
| | - Raquel Maciel
- Gynaecology and Obstetrics, Centro Hospitalar de Entre o Douro e Vouga EPE, Santa Maria da Feira, Portugal
| | - Cristina Costa
- Gynaecology and Obstetrics, Centro Hospitalar de Entre o Douro e Vouga EPE, Santa Maria da Feira, Portugal
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14
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Özdede A, Hatemi G. An evaluation of apremilast for the treatment of adult patients with oral ulcers associated with Behçet's syndrome. Expert Opin Pharmacother 2021; 22:1533-1537. [PMID: 34218739 DOI: 10.1080/14656566.2021.1939307] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
INTRODUCTION Behçet's syndrome is a chronic, multi-system, variable vasculitis of unknown etiology that can result in significant morbidity and mortality. Mucocutaneous lesions such as oral ulcers and genital ulcers are common manifestations that can affect the quality of life of patients significantly. Treatment for mucocutaneous lesions in Behçet's syndrome continues to be critical, and an unmet need remains a significant issue. AREAS COVERED This review evaluates the mechanism of action of apremilast, its effect on the number and pain of oral ulcers, other manifestations, such as genital ulcers, disease activity, quality of life and safety profile in Behçet's syndrome patients. Data from clinical trials as well as observational studies were included. EXPERT OPINION Two randomized placebo-controlled trials and real-world observational data suggest that apremilast is an effective and well-tolerated treatment modality for oral and genital ulcers in Behçet's syndrome. Observational studies additionally showed beneficial results for skin lesions, arthritis, and intestinal involvement.
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Affiliation(s)
- Ayşe Özdede
- Division of Rheumatology, Department of Internal Medicine, Istanbul University -Cerrahpasa, Istanbul, Turkey.,Professor of Medicine, Division of Rheumatology, Department of Internal Medicine and Behçet's Disease Research Center, Istanbul University - Cerrahpasa, Istanbul, Turkey
| | - Gülen Hatemi
- Division of Rheumatology, Department of Internal Medicine, Istanbul University -Cerrahpasa, Istanbul, Turkey.,Professor of Medicine, Division of Rheumatology, Department of Internal Medicine and Behçet's Disease Research Center, Istanbul University - Cerrahpasa, Istanbul, Turkey
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15
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Nowak RG, Liska TA, Bentzen SM, Kim E, Chipato T, Salata RA, Celentano DD, Morrison CS, Gravitt PE. Brief Report: Herpes Simplex Virus Type-2 Shedding and Genital Ulcers During Early HIV in Zimbabwean Women. J Acquir Immune Defic Syndr 2021; 87:789-793. [PMID: 33587502 PMCID: PMC8131209 DOI: 10.1097/qai.0000000000002641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Accepted: 01/25/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND Herpes simplex virus type-2 (HSV-2) seropositive persons have a 3- to 5-fold higher risk of acquiring HIV, possibly because of HSV-2-induced inflammation and recruitment of susceptible immune cells to exposure sites. We hypothesized that cervical HSV-2 activation (ie, viral DNA shedding and/or ulcers) preceded HIV acquisition in the hormonal contraception and HIV cohort. METHODS Zimbabwean women who acquired HIV were matched to HIV-negative women on visit, age, and bacterial sexually transmitted infections. Up to 5 cervical swabs bracketing first polymerase chain reaction detection of HIV DNA (the index visit) were selected (t-6months, t-3months, tindex, t+3months, t+6months). Women with HSV-2 immunoglobulin G+ before tindex were polymerase chain reaction tested for viral shedding. Self-reported and clinician-diagnosed ulcers were documented. Multivariable logistic regression, accounting for matching, estimated adjusted odds ratios (aOR) and 95% confidence intervals (CIs) at each visit. RESULTS Of 387 HSV-2 seropositive women, most had prevalent as compared with incident HSV-2 (91% vs. 9%, respectively). HSV-2 viral shedding was more common among HIV seroconverters than HIV-negative women (26% vs. 14%, P < 0.01). Shedding occurred around HIV acquisition (t-3months aOR, 2.7; 95% CI, 0.8 to 8.8; tindex aOR, 2.6; 95% CI, 1.1 to 6.5; t+3months aOR, 2.6; 95% CI, 1.0 to 6.6). Genital ulcers were reported more often among HIV seroconverters than HIV-negative women (13% vs. 7%; P = 0.06) and detection was after HIV acquisition (t+6months aOR, 14.5; 95% CI, 1.6 to 133.9). CONCLUSIONS HSV-2 shedding appeared synergistic with HIV acquisition followed by presentation of ulcers. Evaluating all sexually transmitted infections rather than HSV-2 alone may clarify the relationship between inflammation and HIV acquisition.
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Affiliation(s)
- Rebecca G Nowak
- Division of Epidemiology and Prevention, Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD
| | - Tobias A Liska
- Nathan Schnaper Internship Program in Translational Cancer Research, Marlene and Stewart Greenebaum Comprehensive Cancer Center, University of Maryland School of Medicine, Baltimore, MD
| | - Søren M Bentzen
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD
| | - Esther Kim
- Beth Israel Lahey Health Beverly Hospital, Beverly MA
| | - Tsungai Chipato
- Department of Obstetrics and Gynecology, University of Zimbabwe, Harare, Zimbabwe
| | - Robert A Salata
- Department of Medicine, Case Western Reserve University, Cleveland, OH
| | - David D Celentano
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; and
| | | | - Patti E Gravitt
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD
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16
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Abstract
Acute genital ulcers (AGU), known as Lipschütz ulcers, are painful vulvar ulcers typically affecting non-sexually active girls and women. AGU have been associated with viral infections, namely, Epstein-Barr virus (EBV). Here, we describe a case of AGU in the setting of SARS-CoV-2 in a non-sexually active adolescent girl hospitalised for pain control and urinary retention, who failed a course of oral corticosteroids and then improved with colchicine. Testing for herpes simplex virus, EBV and Behcet's syndrome were all negative. Testing for SARS-CoV-2 was positive. COVID-19 increases cytokines such as tumour necrosis factor alpha, which has been shown to affect endothelial cell adhesion and neutrophil chemotaxis, leading to aphthosis.
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Affiliation(s)
- Jill M Krapf
- Gynecology, Center for Vulvovaginal Disorders, Washington, DC, USA .,Obstetrics and Gynecology, The George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Rachel K Casey
- Pediatric Specialists of Virginia, Inova Fairfax Medical Campus, Department of Obstetrics and Gynecology, Fairfax, Virginia, USA
| | - Andrew T Goldstein
- Gynecology, Center for Vulvovaginal Disorders, Washington, DC, USA.,Obstetrics and Gynecology, The George Washington University School of Medicine and Health Sciences, Washington, DC, USA
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17
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Muid J, Stephenson KAJ, Hegazy E, Murphy CC. Behçet's disease presenting as bilateral occlusive retinal vasculitis in a young woman. BMJ Case Rep 2021; 14:e241794. [PMID: 33664044 PMCID: PMC7934770 DOI: 10.1136/bcr-2021-241794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/21/2021] [Indexed: 11/03/2022] Open
Affiliation(s)
- Javeria Muid
- Department of Ophthalmology, Royal Victoria Eye and Ear Hospital, Dublin, Ireland
| | - Kirk A J Stephenson
- Department of Ophthalmology, Royal Victoria Eye and Ear Hospital, Dublin, Ireland
| | - Esraa Hegazy
- Department of Ophthalmology, Royal Victoria Eye and Ear Hospital, Dublin, Ireland
| | - Conor C Murphy
- Department of Ophthalmology, Royal Victoria Eye and Ear Hospital, Dublin, Ireland
- Royal College of Surgeons in Ireland, University of Medicine and Health Sciences, Dublin, Ireland
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18
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Hughes Y, Comninos N. Contact dermatitis masquerading as fixed drug eruption: making a critical distinction. BMJ Case Rep 2021; 14:e240805. [PMID: 33622756 PMCID: PMC7907844 DOI: 10.1136/bcr-2020-240805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/07/2021] [Indexed: 11/04/2022] Open
Affiliation(s)
- Yasmin Hughes
- Western Sydney Sexual Health Centre, Western Sydney Local Health District, Parramatta, New South Wales, Australia
| | - Nicholas Comninos
- Western Sydney Sexual Health Centre, Western Sydney Local Health District, Parramatta, New South Wales, Australia
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19
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Abstract
Lymphogranuloma venereum (LGV) has been increasingly reported, and many clinicians are familiar with it as a cause of proctocolitis or inguinal adenopathy. On the other hand, LGV is less commonly considered as a cause of isolated genital ulcerative disease in comparison to other etiologies such as syphilis or herpes simplex. We report a case of persistent perianal ulcerations due to LGV in an HIV-positive patient, confirmed by nucleic acid amplification testing.
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Affiliation(s)
- John D Szumowski
- Division of HIV, Infectious Diseases and Global Medicine, Department of Medicine, University of California San Francisco, San Francisco, California, USA
| | - Carina Marquez
- Division of HIV, Infectious Diseases and Global Medicine, Department of Medicine, University of California San Francisco, San Francisco, California, USA
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20
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Ye Y, Burkholder GA, Wiener H, Aslibekyan S, Khan AE, Shrestha S. HSV-infection-related herpetic anogenital ulcer disease among PLWH in southeastern US: electronic medical record based analysis. Sex Transm Infect 2021; 98:44-49. [PMID: 33436506 PMCID: PMC8784998 DOI: 10.1136/sextrans-2020-054503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Revised: 11/24/2020] [Accepted: 12/22/2020] [Indexed: 11/16/2022] Open
Abstract
The southeastern US is a domestic epicentre for incident HIV with high prevalence of herpes simplex virus (HSV) coinfection. We estimated the incidence rates (IR) of symptomatic herpetic anogenital ulcer disease (HAUD) and assessed its associations with demographic and clinical characteristics, specifically with immunological markers using median, nadir and trajectory CD4 counts.
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Affiliation(s)
- Yuanfan Ye
- Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Greer A Burkholder
- Division of Infectious Diseases, School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Howard Wiener
- Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Stella Aslibekyan
- Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Ashraf E Khan
- Disease Control, Jefferson County Department of Health, Birmingham, Alabama, USA
| | - Sadeep Shrestha
- Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama, USA
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21
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Hughes Y, Lewis DA. HSV-associated proctitis presenting without perianal lesions: why testing and empirical treatment may be important. BMJ Case Rep 2021; 14:14/1/e237247. [PMID: 33431534 PMCID: PMC7802666 DOI: 10.1136/bcr-2020-237247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
A man in his late 30s presented with a several-day history of rectal pain, discharge and bleeding associated with systemic upset. Sexual history revealed receptive anal sex with several male partners in the 2 weeks preceding his clinic visit. Examination of the perianal area was unremarkable. Proctoscopy showed evidence of non-ulcerative proctitis. Microscopy for Gram stain showed pus cells plus extracellular Gram-negative diplococci. The patient was treated for presumptive gonorrhoea and chlamydial infection with ceftriaxone, azithromycin and doxycycline. The patient failed to improve with this treatment regimen. Rectal swab results at 48 hours confirmed the causative agent to be herpes simplex virus (HSV) type 2. The patient was recalled and treated successfully with valaciclovir. This case serves as a useful reminder to clinicians to consider HSV in the differential diagnosis of sexually transmitted proctitis, in the absence of perianal or anorectal ulceration.
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Affiliation(s)
- Yasmin Hughes
- Western Sydney Sexual Health Centre, Parramatta, NSW, Australia
| | - David A Lewis
- Western Sydney Sexual Health Centre, Parramatta, NSW, Australia,Marie Bashir Institute for Infectious Diseases and Biosecurity & Westmead Clinical School, Faculty of Medicine & Health, University of Sydney, Westmead, NSW, Australia
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22
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Abstract
Castleman’s disease is a rare clinicopathological condition characterized by hyperplasia of lymph nodes. We report the case of a 12-year-old boy who presented with painful oral and genital ulcers, who was assumed to have Behçet’s disease. However, the patient did not show any clinical improvement on colchicine and systemic corticosteroids. Later, the patient developed severe abdominal pain and vomiting. Abdominal CT revealed a mass lesion superior to the right kidney. After a thorough investigation, he was diagnosed with unicentric Castleman’s disease. Despite the complete resection of the mass, the patient continued to have the symptoms of abdominal pain and orogenital ulcers. Immunomodulatory therapy resulted in remarkable clinical improvement. This case report demonstrates how unicentric Castleman’s disease can share similar clinical behavior to the multicentric disease.
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Affiliation(s)
- Sawsan A Aljubran
- Family and Community Medicine, Imam Abdulrahman Bin Faisal University, Dammam, SAU
| | - Basim F Khan
- Family and Community Medicine, Imam Abdulrahman Bin Faisal University, Dammam, SAU
| | - Maram M Alqahtani
- Family and Community Medicine, Imam Abdulrahman Bin Faisal University, Dammam, SAU
| | - Ahad Y Shaikh
- Family and Community Medicine, Imam Abdulrahman Bin Faisal University, Dammam, SAU
| | - Rizam A Alghamdi
- Family and Community Medicine, Imam Abdulrahman Bin Faisal University, Dammam, SAU
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23
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Muller EE, Kularatne R. The changing epidemiology of genital ulcer disease in South Africa: has donovanosis been eliminated? Sex Transm Infect 2020; 96:596-600. [PMID: 32075875 DOI: 10.1136/sextrans-2019-054316] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Revised: 01/27/2020] [Accepted: 02/06/2020] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES We used an in-house molecular assay for the detection of Klebsiella granulomatis in ulcer specimens collected over a 12-year surveillance period in order to determine whether a diagnosis of donovanosis could be ascribed to genital ulcer disease (GUD) of unknown aetiology in our setting. METHODS Between 2007 and 2018, a total of 974 genital ulcer specimens with no previously identified sexually transmitted (STI) pathogens were selected from STI aetiological surveys conducted in all nine provinces of South Africa. Giemsa-stained ulcer smears from the same participants had previously been routinely analysed for the presence of typical Donovan bodies within large mononuclear cells. A Klebsiella screening assay targeting the phoE (phosphate porin) gene was used in combination with restriction digest analysis and sequencing to confirm the presence of K. granulomatis. RESULTS The Klebsiella screening assay tested positive in 19/974 (2.0%) genital ulcer specimens. Restriction digest analysis and nucleotide sequencing of the phoE gene confirmed that none of these specimens was positive for K. granulomatis DNA. Similarly, Donovan bodies were not identified in the Giemsa stained ulcer smears of these specimens. CONCLUSIONS This is the first study to assess K. granulomatis as a cause of genital ulceration in South Africa over a 12-year surveillance period using molecular methods. The results demonstrate that K. granulomatis is no longer a prevalent cause of GUD in our population.
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Affiliation(s)
- Etienne E Muller
- STI Section, Centre for HIV & STIs, National Institute for Communicable Diseases, Johannesburg, South Africa
| | - Ranmini Kularatne
- STI Section, Centre for HIV & STIs, National Institute for Communicable Diseases, Johannesburg, South Africa.,Department of Clinical Microbiology & Infectious Diseases, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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24
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Abstract
Genital tuberculosis (TB) in women is a chronic disease with low-grade symptoms. Genital tract tuberculosis is usually secondary to extragenital TB. The fallopian tubes are most commonly affected, and along with endometrial involvement, it causes infertility in such patients. Involvement of the cervix and the vulva is very rare. We present one such rare case of vulvar tuberculosis presented with a large ulcer diagnosed on histopathology and treated with antitubercular chemotherapy.
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Affiliation(s)
- Vishwajeet Singh
- Urology, King George Medical University, Lucknow, Uttar Pradesh, India
| | - Gyanendra Singh
- Urology, King George Medical University, Lucknow, Uttar Pradesh, India
| | - Rahul Janak Sinha
- Urology, King George Medical University, Lucknow, Uttar Pradesh, India
| | - Suresh Babu
- Pathology, King George Medical University, Lucknow, Uttar Pradesh, India
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25
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Ajala-Agbo T, Tang PT, Bat-Ulzii Davidson T. Unilateral leg weakness and pain secondary to metastatic anal squamous cell carcinoma. BMJ Case Rep 2019; 12:12/7/e227563. [PMID: 31308182 DOI: 10.1136/bcr-2018-227563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
A 58-year-old man presented to colorectal clinic with intermittent rectal bleeding, weight loss, also pain and weakness affecting his lower back and right leg. On inspection, there were perianal warts (condyloma acuminata), with an additional palpable anal lesion on digital rectal examination, confirmed by colonoscopy. Subsequent imaging revealed a large right psoas abscess, and an associated paravertebral soft tissue component invading the right lumbosacral plexus and nerve roots at L4, L5 and S1. Biopsy of the paravertebral mass revealed metastatic squamous cell carcinoma. Given his symptomatology, and also as biopsy of the perianal warts revealed high-grade squamous intraepithelial lesion/grade III anal intraepithelial neoplasia on histology with infection by human papillomavirus type 6, the primary was presumed to be anal. This was a case of sciatic pain which proved to be diagnostically challenging on initial presentation to primary care. This mode of presentation and pattern of metastasis are uncommon in anal cancer.
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Affiliation(s)
| | - Pok Tin Tang
- Department of General Surgery, Stoke Mandeville Hospital, Aylesbury, UK
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26
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Abstract
Male genital tract angiomyofibroblastoma (AMF) is a rare benign tumour, with a total of 34 cases reported in literature. We are presenting a case of AMF of the glans penis in a 68-year-old man who presented with a progressively increasing in size large lesion located on the tip of his penis. Following routine investigations, the lesion was surgically excised with no adjuvant treatment, the patient was followed-up for 5 years with no evidence of local, nodal or distant recurrence. As AMF of the glans penis is extremely rare, there is not enough literature to support management guide lines, but it appears that AMF responds very well to complete surgical excision; occasional cases of recurrence have been previously reported, so a long-term follow-up is advised.
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Affiliation(s)
- Sherif Monib
- General Surgery Department, West Hertfordshire Hospitals NHS Trust, Watford, UK
| | - Mohamed Ibrahim
- General Surgery Department, Faculty of Medicine,Fayoum University, Fayoum, Egypt
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27
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Taine S, Norcross C, Pinto-Sander N, Fitzpatrick C, Richardson D. Changing face of the syphilis epidemic in men who have sex with men. Sex Transm Infect 2018; 94:501. [PMID: 30082332 DOI: 10.1136/sextrans-2018-053749] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Revised: 07/03/2018] [Accepted: 07/24/2018] [Indexed: 11/04/2022] Open
Affiliation(s)
- Sarah Taine
- Brighton and Sussex Medical School, Brighton, UK
| | - Claire Norcross
- Brighton and Sussex University Hospitals NHS Trust, Brighton, UK
| | | | | | - Daniel Richardson
- Brighton and Sussex Medical School, Brighton, UK .,Brighton and Sussex University Hospitals NHS Trust, Brighton, UK
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28
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Abstract
Lipschütz ulcers (LU) are non-sexually related genital ulcers, rarely reported. We describe a healthy 11-year-old girl, who presented with fever and a painful vulvar ulcer associated with erythematous tonsillitis. Throat swab test for Group A Streptococcus (GAS) was positive. She was treated with amoxicillin. Further investigation was negative, including Herpes Simplex virus DNA from ulcer swab and serology for Epstein-Barr virus, cytomegalovirus and Mycoplasma pneumoniae Antistreptolysin O titre was high. The ulcer healed in 2 weeks, with no recurrence in a 1 year follow-up period. The association of LU with GAS tonsillitis is very rare.
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Affiliation(s)
- Sara Limão
- Pediatric Department, Hospital Vila Franca de Xira, Vila Franca de Xira, Portugal
| | - Ana Ventura
- Pediatric Department, Hospital de Santa Maria, Lisboa, Portugal
| | - Gustavo Queirós
- Pediatric Department, Hospital Vila Franca de Xira, Vila Franca de Xira, Portugal
| | - Florbela Cunha
- Pediatric Department, Hospital Vila Franca de Xira, Vila Franca de Xira, Portugal
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29
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Gakoué DZ, Tiembré I. Epidemiological aspects of genital ulcers at the STI center of the National Institute of Public Hygiene (Abidjan, Côte d'Ivoire) 2008 to 2010. Med Sante Trop 2017; 27:90-4. [PMID: 28406423 DOI: 10.1684/mst.2017.0660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Genital ulcers are among the seven syndromes of sexually transmitted infections (STIs) identified in Côte d'Ivoire. Ulcerative STIs present a public health problem because of their frequency and their role in the spread of HIV. Our objective was to investigate the epidemiological characteristics of genital ulcers observed in the STI center of the National Institute of Public Hygiene in Abidjan. This cross-sectional, descriptive and analytical study examined cases seen at the center in 2008 through 2010. We retrospectively reviewed all files of clients aged 10 and older who sought care for the first time at the STI center and received a clinical diagnosis, confirmed by the laboratory, of a STI. Overall, we selected 2488 records. Men accounted for 52.30%. The patients' average age was 32 years. The prevalence of genital ulcers was 3.90%. Genital herpes was the diagnosed mentioned most often by doctors (71.43%), followed by scabies (19.39%) and chancroids (9.18%). Male sex and multiple sexual partners appeared to be risk factors for genital ulcers at this center. Genital ulcers are infrequent. Public awareness campaigns to encourage changes in behavior must continue and intensify. In particular, they must stress control of genital herpes by well-known prevention methods: regular and correct condom use and fewer sexual partners.
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30
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Karray M, Litaiem N, Jones M, Zeglaoui F. Sclerosing lymphangitis of the penis associated with marked penile oedema and skin erosions. BMJ Case Rep 2017; 2017:bcr-2017-221414. [PMID: 28754762 DOI: 10.1136/bcr-2017-221414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Sclerosing lymphangitis of the penis is a benign, under-reported condition consisting of a asymptomatic firm cord-like swelling around the coronal sulcus of the penis usually affecting men in the second or third decade of life. Penile oedema and erosions are rarely reported. Clinical signs may be remarkable contrasting with the self-limited character of the disease. We report a new case of sclerosing lymphangitis of the penis occurring in a 59-year-old patient marked by penile swelling and several overlying skin erosions, and discuss the clinical features and the pathogenesis aspects of the disease.
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Affiliation(s)
- Mehdi Karray
- Department of Dermatology, Charles Nicolle Hospital, University of Tunis El Manar, Tunis, Tunisia
| | - Noureddine Litaiem
- Department of Dermatology, Charles Nicolle Hospital, University of Tunis El Manar, Tunis, Tunisia
| | - Mariem Jones
- Department of Dermatology, Charles Nicolle Hospital, University of Tunis El Manar, Tunis, Tunisia
| | - Faten Zeglaoui
- Department of Dermatology, Charles Nicolle Hospital, University of Tunis El Manar, Tunis, Tunisia
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31
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Gawai SR, Binesh VG, Betsy A, Jisha KT. An unusual initial manifestation of acute myeloid leukemia. Int J STD AIDS 2016; 28:418-420. [PMID: 27655838 DOI: 10.1177/0956462416671838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Leukemia cutis is seen in around 20% of acute monocytic leukemia. They usually present as papules or nodules or infiltrated plaques but ulceration is uncommon. A 28-year-old female presented with multiple painless indurated genital ulcers of three weeks' duration with low-grade fever, gum hyperplasia, and generalized lymphadenopathy. Tissue smear from the edge of the ulcer showed atypical monocytes suggestive of leukemic infiltrate which was further confirmed by peripheral smear and bone marrow aspirate. Herein, we report a case of acute monocytic leukemia (AML) with leukemia cutis presenting initially with genital ulcers simulating chancre.
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Affiliation(s)
- Sonali R Gawai
- 1 Department of Dermatology and Venereology, Government Medical College, Thrissur, Kerala, India
| | - V G Binesh
- 1 Department of Dermatology and Venereology, Government Medical College, Thrissur, Kerala, India
| | - Ambooken Betsy
- 1 Department of Dermatology and Venereology, Government Medical College, Thrissur, Kerala, India
| | - K T Jisha
- 2 Department of Pathology, Government Medical College, Thrissur, Kerala, India
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32
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Abstract
The global epidemiology of Haemophilus ducreyi infections is poorly documented because of difficulties in confirming microbiological diagnoses. We evaluated published data on the proportion of genital and nongenital skin ulcers caused by H. ducreyi before and after introduction of syndromic management for genital ulcer disease (GUD). Before 2000, the proportion of GUD caused by H. ducreyi ranged from 0.0% to 69.0% (35 studies in 25 countries). After 2000, the proportion ranged from 0.0% to 15.0% (14 studies in 13 countries). In contrast, H. ducreyi has been recently identified as a causative agent of skin ulcers in children in the tropical regions; proportions ranged from 9.0% to 60.0% (6 studies in 4 countries). We conclude that, although there has been a sustained reduction in the proportion of GUD caused by H. ducreyi, this bacterium is increasingly recognized as a major cause of nongenital cutaneous ulcers.
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33
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Abstract
Patients with vulval aphthae, also termed Lipschütz ulcers, often present to genitourinary medicine clinics. Typically, these ulcers present as acute, painful, vulval ulcers in young women and adolescents. The aetiology is unknown, and often these ulcers are accompanied by flu-like symptoms. Previous case reports have linked such lesions to acute viral infections such as Epstein-Barr virus, cytomegalovirus and influenza A. We report the first case of influenza B virus and adenovirus infections associated with this presentation.
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Affiliation(s)
- G Haidari
- Genitourinary Medicine, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - E MacMahon
- Virology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - C Y W Tong
- Virology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - J A White
- Genitourinary Medicine, Guy's and St Thomas' NHS Foundation Trust, London, UK
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34
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Warren S, Alden K, Lomax N. Behçet's disease - part of the differential diagnosis of ulcerative lesions. Int J STD AIDS 2014; 25:1044-6. [PMID: 24676131 DOI: 10.1177/0956462414529097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This case describes a young white British man with a one-year history of recurrent genital ulceration managed by the GP. Initially this was thought to be a drug reaction; however, presentation at our genitourinary medicine clinic and onward review with dermatology allowed the diagnosis of Behçet's disease to be made. The clinical diagnosis was made based on painful oral and genital ulcers, eye irritation, erythema nodosum and positive pathergy test. Treatment with oral prednisolone was initiated by dermatology, which resulted in rapid improvement in the genital ulceration. This case highlights that clinicians should consider Behçet's disease in patients with recurrent genital ulceration to ensure prompt diagnosis and prevention of systemic involvement.
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Affiliation(s)
- Sian Warren
- Department Integrated Sexual Health, Cardiff Royal Infirmary, Cardiff, UK
| | - Katrin Alden
- The Welsh Institute of Dermatology, University Hospital Wales, Cardiff, UK
| | - Nicola Lomax
- Department Integrated Sexual Health, Cardiff Royal Infirmary, Cardiff, UK
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35
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Abstract
Context: An epidemic of chikungunya disease occurred in India during late 2005 through 2006 affecting nearly 1,400,000 people. Aim: To study the cutaneous manifestations in suspected cases of chikungunya disease. Settings and Design: Patients who attended our outpatient departments from January 2006 to September 2006 were prospectively included if they had symptoms of chikungunya disease according to the ‘case definition’ of the National Institute of Communicable Diseases, Directorate General of Health Services, Government of India. The criteria were an acute illness characterized by the sudden onset of fever and several symptoms such as joint pain, headache, backache, photophobia, and eruption during an epidemic of chikungunya fever in the absence of confirmatory serological tests. Materials and Methods: A total of 115 patients (65 men and 50 women) who satisfied the above criteria were enrolled for the study. Results: An erythematous maculopapular rash subsiding without any sequelae in 3-4 days was the most common cutaneous finding in our patients. Genital ulcers distributed predominantly over the scrotum and base of the penile shaft in men and labia majora in women were the second most common manifestation. Other manifestations included tenderness/edema of hands and feet, grouped hyperpigmented macules over the nose and cheeks, fixed drug eruptions, erythema nodosum, erythema multiformae, generalized urticarial eruptions, and flare up of pre-existing psoriasis and lichen planus. Conclusions: To conclude, a plethora of cutaneous manifestations were noted in suspected cases of chikungunya disease. Genital ulcers, to the best of our knowledge, have not been reported during the earlier epidemics but have been reported by others during the present one.
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Affiliation(s)
- Soma Prashant
- Department of Dermatology and Venereology, Deccan College of Medical Sciences and Allied Institutes i.e., OwaisiHospital and Princess Esra Hospital, India.
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