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Copyright of Journal of Pediatric Infection / Çocuk Enfeksiyon Dergisi is the property of Journal of Pediatric Infection / Cocuk Enfeksiyon Dergisi and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Abstract The female genital ulcer is a manifestation of many diseases, which may vary depending on the etiology, disease duration, age, and host immunity. A middle-aged (40–50 years) woman had a 4-month history of vaginal bleeding. The results of syphilis, herpes, the cervical cancer, tuberculosis, and fungi or acute cervical inflammation caused by Chlamydia trachomatis and Mycoplasma hominis were negative through the blood test and the biopsy. Cervical discharge culture revealed positive for group B Streptococcus and bacterial vaginosis. The patient was treated with oral antibiotics for 7 days. One month later, repeat colposcopy revealed a smooth cervix and complete ulcer disappearance, while cervical discharge culture retested no group B Streptococcus and bacterial vaginosis. The patient was diagnosed with cervical ulcer. Complete medical history taking and bacterial culture of cervical discharge are important for identifying the etiology of the cervical ulcer and deciding the appropriate treatment for the disease.

Paracoccidioidomycosis is a systemic mycosis caused by the fungus Paracoccidioides sp. The genital cutaneous manifestation is rare, with few reports in the literature. We report a case of a male farmer, who presented with a genital cutaneous ulcer for 2 years, without respiratory symptoms. Clinical and histological findings showed paracoccidioidomycosis. This pathology must be considered as an etiology of an ulcerated lesion in the genital tract, even in the absence of respiratory or systemic manifestations.

The female genital ulcer is a manifestation of many diseases, which may vary depending on the etiology, disease duration, age, and host immunity. A middle-aged (40–50 years) woman had a 4-month history of vaginal bleeding. The results of syphilis, herpes, the cervical cancer, tuberculosis, and fungi or acute cervical inflammation caused by Chlamydia trachomatis and Mycoplasma hominis were negative through the blood test and the biopsy. Cervical discharge culture revealed positive for group B Streptococcus and bacterial vaginosis. The patient was treated with oral antibiotics for 7 days. One month later, repeat colposcopy revealed a smooth cervix and complete ulcer disappearance, while cervical discharge culture retested no group B Streptococcus and bacterial vaginosis. The patient was diagnosed with cervical ulcer. Complete medical history taking and bacterial culture of cervical discharge are important for identifying the etiology of the cervical ulcer and deciding the appropriate treatment for the disease. [ABSTRACT FROM AUTHOR]

Report _Case Presentation X Photo Vignette _Letter Authors declare that the contents of this article are their own original unpublished findings. Title: Cutaneous calciphylaxis of the glans penis presenting as a gangrenous ulceration Authors: Marie Danset, Cécile Lesort, Denis Jullien, Jean Kanitakis Affiliations: Dermatology Department, Edouard Herriot Hospital, Hospices Civils de Lyon, Claude Bernard Lyon I University, Lyon, France Corresponding Author: Jean Kanitakis, Department of Dermatology, Edouard Herriot Hospital Group, 69437 Lyon Cedex 03, France, Tel: 33-472110301, Email: jean.kanitakis@univ-lyon1.fr Abstract: Calciphylaxis is a rare microvascular disorder causing necrotic skin ulcers. It is characterized by deposits of calcium within vascular walls but its precise pathogenesis remains poorly understood. A major risk factor is end-stage renal disease on dialysis. We report a 67-year-old man with calciphylaxis revealed by an unusual necrotic ulcer of the glans penis. The patient also presented with bilateral panniculitis of the thighs and a calf ulcer. All those lesions were painful, highlighting the value of pain as a diagnostic clue. Penile involvement of calciphylaxis is rare and biopsy is often avoided in this area. However, rapid diagnosis of calciphylaxis is important because early treatment has a better chance of being successful. Our patient's condition deteriorated rapidly with development of bilateral retinal artery occlusion and he died shortly thereafter. This case further highlights the fact that calciphylaxis is a systemic vascular disease with an ominous prognosis.

Lipschutz ulcer is a rare nonvenereal condition affecting predominantly young females who are not sexually exposed and can be triggered by various infectious agents, trauma, and drugs. It presents with single or multiple painful ulcers over labia minora, labia majora, vestibule, and lower part of the vagina and may be preceded by prodromal symptoms akin to influenza or mononucleosis. Diagnosis is based on specific criteria, which include age, ulcer characteristics, and absence of immunodeficiency. Management involves reassurance, supportive measures, and in severe cases, corticosteroids. This case highlights the importance of considering cytomegalovirus as a potential causative agent in Lipschutz ulcer and a cause for dysplasia. [ABSTRACT FROM AUTHOR]

Neuro-Behçet's syndrome, a severe and rare manifestation of Behçet's disease (BD), can be misdiagnosed due to its challenging clinical presentation. This article presents the case of a 20-year-old cis-gender male with intermittent fever, bilateral uveitis, and neurological symptoms who was found to havemultiple brain stem mass lesions on brain imaging. A careful medical history elicited recurrent painful oral and genital ulcerations which were important in making the correct diagnosis. As there are no validated criteria or definite set of tests available to confirm neuro-Behçet's disease, the diagnosis is often established by exclusion after ruling out other potential etiologies. In our case, after an extensive negative workup for infectious, neuro-degenerative and malignant etiologies combined with the patient'smedical history, a diagnosis of Behçet's disease with neurological involvement (neuro-Behçet's syndrome) was made. High doses of steroids were given, and the patient had a favorable outcome. Repeated magnetic resonance imaging of the brain 2 years later showed no new brain lesions. Neuro-Behçet's disease should be included as a differential diagnosis of unexplained brain stem lesions in the right clinical context. In these situations, providers should obtain medical histories related to genital and oral ulcers and eye problems as these may help to narrow down the diagnosis. The clinical presentation and challenges of this uncommon presentation of BD including a brief literature review of neuro-Behçet's disease with brain stem mass lesions are discussed in this case study. [ABSTRACT FROM AUTHOR]

Introduction: Sexually transmitted diseases (STDs) continue to be a major public health problem with significant burden on the society. Some of this can be attributed to our lack of knowledge about the change of disease spectrum from time to time. Aims: The aim of the study was to understand the changing pattern of STDs over the past 17 years (2003–2019). Materials and Methods: It was a retrospective study where data of patients who attended our Suraksha Clinic from 2003 to 2019 were collected. All the cases were subjected to detailed history, examination, and investigations done to rule out STDs. Results: A total of 2436 patients were included in the study. The majority of the patients were in the age group of 18–30 years. The most frequent diagnosis was vulvovaginal candidiasis, followed by herpes genitalis. 3.3% of patients had human immunodeficiency virus. 4.8% of patients were men sex men (MSM). Overall, viral STDs were most common, followed by fungal and bacterial. To understand the changing trends, data were divided into different phases according to the time period. During Phase 1 (2003–2007), viral STDs were most common, followed by bacterial and fungal. However, this trend changed in Phase 4 (2016–2019) and fungal STDs became most common. Conclusions: Despite numerous health initiatives, the number of STD cases is rising day by day. The increasing number of MSM over the study period necessitates dedicated efforts to address the health needs of this population. The National AIDS Control Organization should take necessary measures and steps to address the overall increase in STDs considering recent trends showing a drop in bacterial STDs and an increase in fungal and viral STDs. [ABSTRACT FROM AUTHOR]

Neuro-Behçet's syndrome, a severe and rare manifestation of Behçet's disease (BD), can be misdiagnosed due to its challenging clinical presentation. This article presents the case of a 20-year-old cis-gender male with intermittent fever, bilateral uveitis, and neurological symptoms who was found to have multiple brain stem mass lesions on brain imaging. A careful medical history elicited recurrent painful oral and genital ulcerations which were important in making the correct diagnosis. As there are no validated criteria or definite set of tests available to confirm neuro-Behçet's disease, the diagnosis is often established by exclusion after ruling out other potential etiologies. In our case, after an extensive negative workup for infectious, neuro-degenerative and malignant etiologies combined with the patient's medical history, a diagnosis of Behçet's disease with neurological involvement (neuro-Behçet's syndrome) was made. High doses of steroids were given, and the patient had a favorable outcome. Repeated magnetic resonance imaging of the brain 2 years later showed no new brain lesions. Neuro-Behçet's disease should be included as a differential diagnosis of unexplained brain stem lesions in the right clinical context. In these situations, providers should obtain medical histories related to genital and oral ulcers and eye problems as these may help to narrow down the diagnosis. The clinical presentation and challenges of this uncommon presentation of BD including a brief literature review of neuro-Behçet's disease with brain stem mass lesions are discussed in this case study.

Sexually transmitted infections (STIs) are a global health problem. The STI Committee of the Colombian Infectious Diseases Association (ACIN) developed this document aimed primarily at medical professionals at different levels of healthcare throughout Colombia, with the objective of providing clear and concrete recommendations for a timely diagnosis and treatment of patients with STIs and their contacts. These protocols were designed based on the available scientific evidence and existing guidelines prepared by national and international scientific societies and government groups. The most common STIs were classified into the following sections: urethritis, genital ulcer, vaginal discharge with infectious etiology, proctitis, cervicitis, hepatitis B, and high-risk human papillomavirus. For each protocol, we present the definition, etiology, conditions for collecting clinical samples, diagnostic tests by etiological agent and level of care, and treatment by etiological agent.

Coronavirus disease 2019 (COVID-19), as a pandemic disease and a global concern, is a respiratory tract infection caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Besides its common symptoms, some other less common symptoms, including genital ulcers, have been reported. Other complications such as autoimmune disease can present with genital ulcers. Differential diagnosis includes Reiter syndrome, Behcet's disease, and psoriasis. We report a 32-year-old married man with genital ulcers due to COVID-19 infection and as a complication of his disease. [ABSTRACT FROM AUTHOR]

Copyright of Osmangazi Journal of Medicine / Osmangazi Tip Dergisi is the property of Eskisehir Osmangazi University and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Bechet's disease is a multisystemic inflammatory disease of unknown causes, characterized by painful oral and genitalia ulcers, eye involvement, and other systemic manifestation. Bechet's disease is a clinical diagnosis with no specific laboratory test and rarely encountered in urological practices. Here, we are reporting a case of Bechet's diseases in a patient who presented with painful scrotal ulcers underwent examination under anesthesia to role out scrotal abscess and histopathology evaluation of scrotal skin biopsy supporting the diagnosis of Bechet's disease.

Behçet’s disease is a rare vasculitis of unknown aetiology though there is a strong genetic association with HLA-B51 characteristically targets small arteries and venules. Multiple deep oral ulcer and genital ulcer is a common presentation. Ocular involvement is also commonly occurs in the form of anterior or posterior uveitis or retinal vasculitis. Neurological manifestation occurs in the form of brainstem or pyramidal tract symptom.Thrombosis can occur but renal involvement is unlikely. Our patient Mrs X, 47 year old has been suffering from recurrent episode of oral ulcer, genital ulcer, redness of eye and dysphagia for the last 12 years.T here was relapse and remission of the symptoms. Her Ophthalmoscopic examination was normal. Upper GI endoscopy revealed multiple esophageal ulcers. ANA, Anti CCP, cANCA, pANCA, HSV 1&2- IgM, CMV- IgM,TPHA,Anti -HIV 1&2 were negative. She was treated with oral steroid and azathioprine and all the lesions resolved completely. [ABSTRACT FROM AUTHOR]

Acute genital ulcers are painful and distressing. Lipschutz ulcer (LU), also known as ulcus vulvae acutum, is a rare and underdiagnosed entity presenting as an acute painful vulvar ulcer in young women. Although the etiology is not known, recent reports have associated it with infections such as Epstein–Barr virus, cytomegalovirus (CMV), Mycoplasma pneumoniae, Mycoplasma fermentans, mumps, and parvovirus B19. The diagnosis is made by exclusion, after ruling out the usual causes of genital ulcerations such as sexually transmitted diseases, autoimmune causes, trauma, drug reactions, and local manifestations of systemic illnesses. We report the case of a 10-year-old girl who developed flu-like symptoms, followed by painful vulvar ulcers within 2 days. Lipshutz ulcer must br considered among the causes of genital ulcers.

Background: Ulcus vulvae acutum, also known as Lipschütz ulcer, is a rare condition characterized by multiple, painful, and acute genital ulceration in young women without venereal infections, associated with systemic symptoms like malaise, fever, and inguinal lymphadenopathy. Case Illustration: A 24-year-old woman developed multiple and painful vulvar ulcers that recurred for almost a year. The patient was primarily diagnosed and treated as genital herpes in several hospitals with only slight improvement and no complete healing. The patient came to our hospital for examinations to rule out sexually-transmitted infection (STI) (genital herpes, syphilis, HIV, and chancroid) and possibility of Behçet’s. The patient was treated with a combination of 2.5% lidocaine and 2.5% prilocaine creams for 1 week, 2% fusidic acid ointment for 1 week, with no significant progression. Later, the therapy was changed to 0.05% clobetasol propionate ointment for 10 days. Complete healing occurred in about 10 weeks with no scarring. Discussion: Diagnosis of ulcus vulvae acutum in this patient was made by excluding other differential diagnoses. Conclusion: Ulcus vulvae acutum is a difficult diagnosis, and clinician should be aware of this entity especially when encountering young woman without previous sexual experience problem with ulcer.

Calciphylaxis is a rare microvascular disorder causing necrotic skin ulcers. It is characterized by deposits of calcium within vascular walls but its precise pathogenesis remains poorly understood. A major risk factor is end-stage renal disease on dialysis. We report a 67-year-old man with calciphylaxis revealed by an unusual necrotic ulcer of the glans penis. The patient also presented with bilateral panniculitis of the thighs and a calf ulcer. All those lesions were painful, highlighting the value of pain as a diagnostic clue. Penile involvement of calciphylaxis is rare and biopsy is often avoided in this area. However, rapid diagnosis of calciphylaxis is important because early treatment has a better chance of being successful. Our patient's condition deteriorated rapidly with development of bilateral retinal artery occlusion and he died shortly thereafter. This case further highlights the fact that calciphylaxis is a systemic vascular disease with an ominous prognosis. [ABSTRACT FROM AUTHOR]

Behçet's disease (BD) is a chronic, relapsing, systemic inflammatory disease with clinical features showing mucocutaneous lesions involving the ocular, articular, and further miscellaneous organs. Mucocutaneous manifestations, one of the most characteristic signs of BD, have been most commonly observed upon onset or at any disease stage and are exceptionally important in its diagnosis. Given the lack of specific diagnostic laboratory tests for BD, diagnosis has been based on clinical findings. All diagnostic criteria published have thus far relied heavily on mucocutaneous manifestations, particularly oral ulcers (OU), genital ulcers (GU), cutaneous lesions, and pathergy test positivity. Worldwide, OU, GU, cutaneous lesions, and ocular and articular manifestations have been the most common symptoms, with erythema nodosum (EN)-like lesions and papulopustular lesions being the most prevalent cutaneous manifestations. While majority of the patients worldwide have reported OU as the most frequent symptom upon disease onset, GU, and EN-like lesions have also been identified upon onset. Considering that mucocutaneous symptoms precede severe organ involvement in most patients, familiarity with such symptoms is imperative for early diagnosis and prevention of potentially serious organ involvement through appropriate management.

Objectives: This study aims to determine the incidence of fibromyalgia (FM) in female patients with Behçet's disease (BD) and to investigate whether disease activity changes in the presence of FM in female patients with BD. Patients and methods: This cross-sectional study included 72 female patients with BD (mean age 39.7±10.5 years; range, 22 to 74 years) between June 2018 and February 2019. The frequency of FM was evaluated according to the American College of Rheumatology alternative criteria. Active clinical features and BD activity were evaluated with the Behçet's disease activity form (BDCAF). Results: The prevalence of FM was 29.2% in the BD patients. BD clinical activity index, patients' perceptions of disease activity and clinicians' overall perceptions of disease activity scores were significantly higher in BD patients with FM (p=0.003, p<0.001 and p=0.025, respectively). The active clinical features of BD were not different between the groups except for genital ulcer. The prevalence of active genital ulcers was higher in BD patients with FM than in BD patients without FM (38.1% vs. 13.7%, respectively). Conclusion: Disease activity is higher in female BD patients with FM than those without FM. High disease activity in female BD patients with FM may be associated with the presence of genital ulcers. [ABSTRACT FROM AUTHOR]

Introduction: The landscape for the treatment of metastatic melanoma has been revolutionized with the introduction immune checkpoint inhibitors. Immune checkpoint inhibitors have now become the standard of care for the treatment of cancers. These immune agents including programmed death receptor-1 inhibitors, programmed death-ligand 1 inhibitors and cytotoxic T-lymphocyte antigen-4 inhibitors have shown promising results but have been associated with numerous immune-related complications. Pembrolizumab, a programmed death receptor-1 inhibitor, has been associated with a number of immune-related adverse events affecting multiple organ systems including integument, ocular, endocrine, cardiovascular, pulmonary, renal, gastrointestinal, and musculoskeletal system. Case report: We present a case of an 88-year-old Caucasian male with metastatic melanoma of the face with metastasis to the right fifth cranial nerve and into the right cavernous sinus. He underwent resection of the melanoma and was placed on pembrolizumab at 2 mg/kg every three weeks. Interestingly, 24 months on pembrolizumab therapy, he developed corneal erosions, oral and genital ulcerations. Management and outcome: Patient completed his 24 months of pembrolizumab and was started on prednisone and colchicine with improvement in his symptoms. At his follow-up eight months, he had recurrence of an oral ulcer. Discussion: Here we present a rare case of an elderly male on pembrolizumab who suffered from corneal erosions, oral and genital ulcers, a syndrome similar to Behcet's disease. Given that pembrolizumab and other immune checkpoint inhibitors are being utilized in the treatment of cancers, physicians should be aware of the wide range immune-related adverse events including the possible Behcet's-like syndrome presentation. [ABSTRACT FROM AUTHOR]

Paracoccidioidomycosis is a systemic mycosis caused by the fungus Paracoccidioides sp. The genital cutaneous manifestation is rare, with few reports in the literature. We report a case of a male farmer, who presented with a genital cutaneous ulcer for 2 years, without respiratory symptoms. Clinical and histological findings showed paracoccidioidomycosis. This pathology must be considered as an etiology of an ulcerated lesion in the genital tract, even in the absence of respiratory or systemic manifestations. [ABSTRACT FROM AUTHOR]

Background: Chikungunya fever is caused by chikungunya virus which is transmitted by the bite of infected Aedes aegypti and A. albopictus mosquitoes. Aims: To study the various mucocutaneous manifestations in suspected cases of chikungunya fever. Materials and Methods: The patients who attended our outpatient department from July 2016 to October 2016 and fulfilled the criteria for “suspect cases” of chikungunya infection stipulated by the National Institute of Communicable Diseases, Directorate General of Health Services, Government of India, were included in the study prospectively. A total of 112 patients (62 males and 50 females) with mucocutaneous manifestations of chikungunya fever were enrolled in the study. Results: Mucocutaneous manifestations were found more in males than females. Serological immunoglobulin M enzyme-linked immunosorbent assay (IgM ELISA) test for chikungunya virus was positive in 62 (55.3%) patients. Generalized erythematous maculopapular rash (53.5%) was the most common finding. Genital pustular rash with aphthae (4.4%), oral and intertriginous aphthae, red lunula, subungual hemorrhage, localized erythema of the ear pinnae, erythema, swelling, and eczematous changes over the preexisting scars and striae (scar phenomenon) were the other interesting findings. Various pattern of pigmentation (37.5%) were observed including striking nose pigmentation in a large number of patients, by looking at which even a retrospective diagnosis of chikungunya fever could be made. There was flare-up of existing dermatoses like psoriasis and dermatophytic infection. Conclusions: Wide varieties of the mucocutaneous manifestations were observed in our study, but the striking nose pigmentation was present irrespective of age and this peculiar pigmentation may be considered as a specific clinical marker of chikungunya fever. Chikungunya fever must be suspected in any patient with painful oro-genital and intertriginous aphthous-like lesions associated with febrile polyarthralgia with rash.

Hydroxyurea is a chemotherapeutic agent used for myeloproliferative disorders and sickle cell anemia that is well known to cause painful mucocutaneous ulcers, typically involving the legs or mouth. However, genital ulcerations due to hydroxyurea therapy are a rare, and likely underrecognized, adverse effect with only a few cases reported in the literature to date. Ulcers of the lower legs caused by hydroxyurea are associated with a diagnostic delay, and this is likely exacerbated in cases of genital ulceration due to a lack of awareness. Herein we present two cases of painful genital ulceration in patients on hydroxyurea therapy. In the first Case, an 87 year-old male with polycythemia vera developed an ulcer on the scrotum, which was assessed initially through virtual visits during the COVID-19 pandemic, and was refractory to topical and oral antibiotic treatments. The second case was a 79 year-old male with essential thrombocythemia and a history of persistent leg ulcers who developed erosions of the glans penis. Both patients experienced complete resolution within weeks of discontinuing hydroxyurea therapy. In conclusion, genital ulcers and erosions induced by hydroxyrea may be underrecognized in clinical practice, but if identified, withdrawal of hydroxyurea leads to quick resolution of these lesions and the associated pain. [ABSTRACT FROM AUTHOR]

An epidemic of lymphogranuloma venereum among men who have sex with men (MSM) has persisted in Australia for over a decade and virtually all diagnoses are made from rectal samples. We discuss two cases of human immunodeficiency virus-negative MSM who presented with a penile ulcer. The diagnosis can be made by ensuring a swab of any such ulcer is tested for Chlamydia trachomatis. [ABSTRACT FROM AUTHOR]

Pyoderma gangrenosum (PG) is a non-infectious and inflammatory ulcerative dermatosis (or neurotrophic ulcer in the skin that appears in more than half of cases in patients with a history of ulcerative colitis and crohn). In this study, a case of pyoderma gangrenosume after cesarean section surgery was reported. A 29-year-old woman with a history of cesarean section referred to Yasuj Shahid Beheshti Hospital due to genital ulcer and oral ulcer. Antibiotic therapy began. Genital ulcer sampling was performed and with pathologic response, PG was discharged by prescribing corticosteroid and good general health and recovered after 40 days. According to the results of pathology and tests performed to exclude other diseases and differential diagnosis, the final diagnosis is podermagangrenosome. The treatment of Pyoderma gangrenosum, by performing an operation to remove the condition, increases the chance of mechanical stimulation and subsequent recurrence of this complication. Proper and timely drug interventions are the first treatment option for this disease. [ABSTRACT FROM AUTHOR]

Acute genital ulcers are painful and distressing. Lipschutz ulcer (LU), also known as ulcus vulvae acutum, is a rare and underdiagnosed entity presenting as an acute painful vulvar ulcer in young women. Although the etiology is not known, recent reports have associated it with infections such as Epstein–Barr virus, cytomegalovirus (CMV), Mycoplasma pneumoniae, Mycoplasma fermentans, mumps, and parvovirus B19. The diagnosis is made by exclusion, after ruling out the usual causes of genital ulcerations such as sexually transmitted diseases, autoimmune causes, trauma, drug reactions, and local manifestations of systemic illnesses. We report the case of a 10-year-old girl who developed flu-like symptoms, followed by painful vulvar ulcers within 2 days. Lipshutz ulcer must br considered among the causes of genital ulcers. [ABSTRACT FROM AUTHOR]