Shiloh
Editor, Senior Moderator
Source: https://www.nejm.org/doi/full/10.1056/NEJMcpc2201244
Case 24-2022: A 31-Year-Old Man with Perianal and Penile Ulcers, Rectal Pain, and Rash
List of authors:
Nesli Basgoz, M.D., Catherine M. Brown, D.V.M., M.P.H., Sandra C. Smole, Ph.D., H.C.L.D. (A.B.B.), Lawrence C. Madoff, M.D., Paul D. Biddinger, M.D., Joshua J. Baugh, M.D., M.P.P., M.H.C.M., and Erica S. Shenoy, M.D., Ph.D.
June 15, 2022
DOI: 10.1056/NEJMcpc2201244
Presentation of Case
Dr. Vivian De Oliveira Rodrigues Gama (Medicine): A 31-year-old man was admitted to this hospital because of perianal and penile ulcers, rectal pain, and vesiculopustular rash.
The patient had been in his usual state of health until 9 days before this admission, when he noticed several itchy white “bumps” around the anus that subsequently evolved into ulcerative lesions. The next day, he sought evaluation at a primary care clinic of another hospital. Tests for human immunodeficiency virus (HIV), syphilis, gonorrhea, and chlamydia were performed. An injection of penicillin G benzathine was administered, and treatment with valacyclovir was started.
During the next 5 days, the perianal ulcers did not abate, and the patient stopped taking valacyclovir. Painful proctitis with rectal bleeding and malodorous, mucopurulent discharge developed, along with fever, chills, drenching sweats, and new tender swelling in the groin. Three days before this admission, a new painless ulcer appeared on the penis that was similar in appearance to the perianal ulcers. Two days before this admission, new scattered vesicular lesions appeared on the arms and legs, and the patient presented to the infectious disease clinic of this hospital for evaluation...
Case 24-2022: A 31-Year-Old Man with Perianal and Penile Ulcers, Rectal Pain, and Rash
List of authors:
Nesli Basgoz, M.D., Catherine M. Brown, D.V.M., M.P.H., Sandra C. Smole, Ph.D., H.C.L.D. (A.B.B.), Lawrence C. Madoff, M.D., Paul D. Biddinger, M.D., Joshua J. Baugh, M.D., M.P.P., M.H.C.M., and Erica S. Shenoy, M.D., Ph.D.
June 15, 2022
DOI: 10.1056/NEJMcpc2201244
Presentation of Case
Dr. Vivian De Oliveira Rodrigues Gama (Medicine): A 31-year-old man was admitted to this hospital because of perianal and penile ulcers, rectal pain, and vesiculopustular rash.
The patient had been in his usual state of health until 9 days before this admission, when he noticed several itchy white “bumps” around the anus that subsequently evolved into ulcerative lesions. The next day, he sought evaluation at a primary care clinic of another hospital. Tests for human immunodeficiency virus (HIV), syphilis, gonorrhea, and chlamydia were performed. An injection of penicillin G benzathine was administered, and treatment with valacyclovir was started.
During the next 5 days, the perianal ulcers did not abate, and the patient stopped taking valacyclovir. Painful proctitis with rectal bleeding and malodorous, mucopurulent discharge developed, along with fever, chills, drenching sweats, and new tender swelling in the groin. Three days before this admission, a new painless ulcer appeared on the penis that was similar in appearance to the perianal ulcers. Two days before this admission, new scattered vesicular lesions appeared on the arms and legs, and the patient presented to the infectious disease clinic of this hospital for evaluation...