Simple cases

No image for NaN

Case 25



No. The lack of pain in a lesion which looks as if it should hurt helps with the diagnosis.

For 3-4 months.

The time course of a disease often gives clues to the etiology.

At first there was a swelling in my groin. Then it started draining, and now the whole thing has gotten larger.

The clinical evolution of a lesion often gives clues to the etiology.


Information about previous tests and treatments might help.


Some patients with chronic infections develop systemic findings.


Many infections have a protal of entry, so it is smart to ask.

I broke my arm ten years ago.

One must take a history but it doesn't always help.

Choose the right efflorescences:

An erosion is a superficial non-scarring defect.

There is a bizarre ulcer with fibrinous debris and islands of re-epithelization.

No vesicle or blister is seen.

A fissure is a long thin defect, not seen here.

Choose the right diagnosis:

Uncommon sexually transmitted disease, usually seen in tropical lands, but occasionally epidemics in focal areas in Western lands. Caused by Calymmatobacterium granulomatis.

Herpes simplex can cause big ulcers, especially in HIV-infected patients, but otherwise the lesions are more superficial.

Burns usually spare the body folds, and there is no history.

Hidradenitis suppurativa involves the groin and axillae. Individual lesions look like boils and heal with fistulas and scarring.

Artifact is a diagnosis of exclusion, but this lesion really does not appear self-induced. Often such lesions are a bit too linear or rectangular, if made with an instrument, or look splattered if made with a caustic.

Choose the right therapy(ies):

This the is recommended regimen for granuloma inguinale, which responds well. Healing with scarring is anticipated.

Surgical treatment is not indicated. The antiobiotic regimen is that for neurosyphilis and is not indicated here.

This is another possible approach.

There is no good topical therapy for granuloma inguinale. In addition, the peroxide would be so painful that the patient would not complete the treatment.

Mark article as unread
Article has been read
Mark article as read