Naslov
Unusual genital ulceration

Autori
Kuna, Matea ; Čulina, Lucija ; Špičić, Sara ; Čulav, Ivana

Vrsta, podvrsta i kategorija rada
Sažeci sa skupova, ostalo, stručni

Skup
THE 6th INTERNATIONAL SYMPOSIUM SEXUALLY TRANSMITTED INFECTIONS - NEW HORIZONS

Mjesto i datum
Brijuni, Hrvatska, 16.09.2022. - 18.09.2022

Vrsta sudjelovanja
Poster

Vrsta recenzije
Domaća recenzija

Ključne riječi
Genital ulceration ; Behçet disease ; Multisystem vasculitic disease

Sažetak
INTRODUCTION Behçet disease (BD) is rare, multisystem vasculitic disease with multiorgan involvement. It has strongly variable ethnic prevalence highest in Turkey, Japan, Korea, Southeast Asia, the Middle East, southern Europe with the age of onset in 3rd and 4th decades, occuring more often in men. Etiology of the disease is unknown, might be an autoimmune disorder, associated with several genetic factors (particularly HLA B51) and potential triggers such as S. sanguis, HSV, hepatitis viruses and parvovirus B19. The lesions are the result of leukocytoclastic (acute) and lymphocytic (late) vasculitis. The diagnosis of BD is made according to the Revised International Criteria for BD, including clinical findings and positive pathergy test. Main symptoms of BD are recurrent oral aphthous ulcers, genital ulcers, erythema nodosum, superficial thrombophlebitis, skin pustules, iridocyclitis, and posterior uveitis. Additional symptoms may be arthritis, epididymitis, ileocecal ulcerations, vascular, and central nervous system (CNS) lesions. Treatment should be aimed at aphthous ulcers and systemic involvement. CASE REPORT A 52-year-old male patient was referred to our Department with a three-month history of symmetrically disseminated pustules, erythematous and violaceous papules with central surface ulcerations in inguinal and pubic areas, on the corpus of the penis and in the right gluteak region. A shallow ulceration was demarceted on the left side of the tongue. There was symmetrical conjunctival hyperemia. The patient reported itch, tightness and pain around the present skin lesions as well as muscle spasms. There was no history of any provoking infection factors. The patient was treated by an infectologist with acyclovir orally 5x800 mg for 7 days in two separate intervals, without improvement. In 1993 the patient was diagnosed with a teratoma of the right testicle, and an orchiectomy with lymphadectomy was performed. In 2015 he was treated for diverticulitis and, in 2016 for cervical pain. Our patient also reported multiple swelling of testicles and epididymitis for which, was treated three times with antibiotics by urologists in 2021. The patient has been suffering from arterial hypertension for 6 years. His therapy included amlodipine/valsartan/hydrochlorothiazide, moxonidine and tamsulosine-choride. He reported allergy to cefuroxime. Laboratory tests which included complete blood cell count, biochemistry, anti-tTG IgA were all within normal limits, with the exception of elevated GUK (6.5 mmol/L), albumins 66.4 %, TSH 5.081, TPSA 4.070, ANA, ENA, ANCA were negative. Positive antigen H. pylori in the stool. A biopsy of violaceous papule of the skin in the right inguinum was performed. The histopathological sample (hematoxylin and eosin staining) showed: orthokeratotic surface with regular epidermal structure and central ulceration. Dense mononuclear and polymorphonuclear infiltrates were founded perivascularly in the dermis with signs of leukocytoclasia and erythrocyte extravasation. Pathergy test was performed with positive result after 48 hours. Ophtalmological examination revealed conjuctival hyperemia that was subsequently treated with dexamethasone ointment with significant improvement. The patient was also examined by a clinical imunologist who started treatment with oral metotrexate 15 mg once a week combined with a tablet of folic acid 5 mg 24 hours after methotrexate, together with prednisone 20 mg daily initially, later tapered to 10 mg daily. Neurologists performed diagnostic tests: TCD, EEG were normal, EMNG of upper and lower extremities showed initial signs of axonal polyneuropathy. CD of arteries of upper and lower extremities were without signs of claudications, CDFI and PDI were normal. Auditory and visual evoked potentials were normal. Skin lesions were treated with combined betametasone and gentamycin cream twice daily for 7 days, than topical 40% mometasone with emollient cream once daily during 14 days. Oral cavity ulcers were treated with solution based on prednisone, miconazole, lidocaine and glycerin. Partial regression of skin and mucosa lesions were reported following treatment. A month later, on the subsequent follow-up examination, only residual hyperpigmented macules were present with no recurrences of lesions on the skin, but with mild ulceration in oral cavity. Patients' treatment continues to be supervised by a clinical immunologist, who confirmed the diagnosis of Behçet disease upon collecting the results of the relevant diagnostic tests.

Izvorni jezik
Engleski

Znanstvena područja
Biotehnologija u biomedicini (prirodno područje, biomedicina i zdravstvo, biotehničko područje)

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