engleski

UNUSUAL CASE OF PERIANAL ULCERATION

A wide range of infectious, neoplastic, and inflammatory dermatoses can affect the anogenital region and manifest with ulcerations. The most frequent causes of painful genital ulcers are herpes simplex infection, syphilis and Haemophilus ducreyi infection (chancroid). Granuloma inguinale and lymphogranuloma venereum are rare causes of genital ulcerations. However , various other infectious and noninfectious dermatoses should also be considered as a possible cause of ulcerations in anogenital region. We present a case of a 22- year-old patient who, during a physical examination, had an ulceration of 1cm in diameter surrounded by a few smaller ulcerations in the perianal region. All the ulcerations were painful on palpation, with a yellowish discharge appearing on pressure. There was no regional lymphadenopathy and the patient denied having any prodromal symptoms. The patient history revealed occasional sexual intercourse with male partners. The first suspected diagnosis was syphilis with the coexistence of herpes genitalis, but due to the clinical picture and patient history, lymphogranuloma venereum was also suspected. Serology for syphilis, HIV and hepatitis was negative. Urethral swabs for Chlamydia trachomatis, Mycoplasma hominis, Mycoplasma genitalis were negative, except for Ureaplasma urealyticum which was unremarkably positive 103. Perianal and rectal swabs for Chlamydia trachomatis, Neisseria gonorrhoeae, Mycoplasma hominis, Mycoplasma genitalis and Ureaplasma urealyticum were positive for Neisseria gonorrhoeae. Polymerase chain reaction (PCR) analysis for HSV 1 and HSV2 of perianal ulcerations was positive (HSV IgM: positive). The patient was treated with acyclovir 3x400 mg for 7 days, doxycycline 2x100 mg for 3 weeks and ceftriaxone 1gr intramuscular injection, which led to complete resolution of clinical symptoms. We believe that our patient had perianal ulcerations of multiple etiologies combined, such as herpes simplex infection, gonorrhea and/or lymphogranuloma venereum. All the patients with genital ulcers thought to be caused by an STI should be tested for syphilis, HIV, and herpes simplex, and also to other STI causative agents like Neisseria gonorrhoeae and Chlamydia trachomatis (serovars L1, L2, and L3), depending on patient’s history.

anogenital ; ulceration

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