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Published:July 29, 2022
DOI:https://doi.org/10.1016/S1473-3099(22)00504-7
Simone Vasilij Benatti, MD, Serena Venturelli, MD, Natalia Comi, MD, Federica Borghi, MD, Stefania Paolucci, MD, Prof Fausto Baldanti, MD
A 39-year-old, White, bisexual male attended our sexual health clinic with proctitis and a cluster of vesicles (2–3 mm) in the anal region, which had presented 3 days previously. He declared having had multiple unprotected sexual encounters and being on pre-exposure prophylaxis for HIV prevention since 2019. Over the previous 3 weeks, he had travelled to France and Germany, before returning to Italy.
7 days before the vesicles appeared, he had experienced back myalgia, suspected fever (not measured), and a non-productive cough that resolved within 48 h. 4 days later, he developed conjunctivitis of the left eye, with a small vesicle on the lower eyelid. After consulting an ophthalmologist, he was given topical co-formulated neomycin (3500 IU/mL), polymixin B (6000 IU/mL), and dexamethasone (1 mg/mL) in an ointment to be applied twice a day and in an eye drops formulation to be applied five times a day.
On examination at our clinic, he had three more vesicles each on the upper back and on the thigh, but no adenopathy. The left eye blepharoconjunctivitis had evolved into a single whitish ulcer (10 mm) on the medial bulbar conjunctiva, with regular edges. The smaller vesicle on the lower eyelid (lateral; figure) was still present. Neither corneal, nor anterior chamber involvement, were found on ophthalmologic examination. Topical treatment, as outlined above, was continued to completion 2 weeks later.
https://www.thelancet.com/action/sho...2822%2900504-7