Acta Dermato-Venereologica Issue 8, 2017 97-8CompleteContent | Page 33

995 Sudden Genital Ulceration in a Young Man: A Quiz Marco CUSINI 1 , Susanna BENARDON 1 , Michela BRENA 1 , Stefano RAMONI 1 , Vinicio BONESCHI 1 and Raffaele GIANOTTI 2 1 Department of Dermatology – STD Centre, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, IT-20122 Milan, and 2 Department of Dermatology, University of Milan, Milan, Italy. E-mail: [email protected] A 24-year-old circumcised man presented with an ulce- rative lesion on the penis which had been present for 3 days. He reported that the lesion had appeared after sexual intercourse with his girlfriend. He had been circumcised in childhood for religious reasons. Clinical examination revealed an ulcerative and crusted posthitis with multiple ulcers, penile oedema and bilateral inguinal lymphadenopa- thy (Fig. 1). The patient reported having fever and malaise. Cutaneous swabs for herpes simplex virus types 1 and 2, Treponema pallidum and Chlamydia trachomatis PCR were negative, whereas cutaneous swab for bacterial culture de- tected Streptococcus pyogenes and Staphylococcus aureus. Serological tests for syphilis, HIV and hepatitis C virus were negative. Systemic therapy with ceftriaxone, 1 g i.m. for 5 days, was prescribed, which resulted in improvement in the ulcerative lesions and general symptoms, but hard penile oedema was still present. The patient denied any aberrant sexual activity or other sexual practices, even upon further questioning. The per- sonal history of the otherwise healthy patient was incon- spicuous. A biopsy from the thick portion on the penis was per- formed. What is your diagnosis? See next page for answer. Fig. 1. Ulcerative and crusted posthitis with multiple ulcers and penile oedema. QUIZ SECTION This is an open access article under the CC BY-NC license. www.medicaljournals.se/acta Journal Compilation © 2017 Acta Dermato-Venereologica. doi: 10.2340/00015555-2688 Acta Derm Venereol 2017; 97: 995–996