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Persistent Perineal Ulcerations

Persistent Perineal Ulcerations Abstract REPORT OF A CASE A 26-year-old white man with the human immunodeficiency virus (HIV) presented with a 5-month history of nonhealing and painful ulcerations in the groin and perirectal region. These areas had previously been treated with bacitracin zinc and polymyxin B sulfate (Polysporin ointment), fluconazole, doxycycline, acyclovir, and rifampin, none of which resulted in improvement of the erosions. Previous cultures from the area yielded diphtheroids, Staphylococcus epidermidis, and Enterococcus faecalis.The physical examination revealed a well-defined 4-cm erythematous erosion with a slightly raised margin present within the right inguinal fold extending onto the upper medial aspect of the right thigh and onto the scrotal sac (Figure 1). In the perirectal region, there was an 8×5-cm erythematous erosion with a similar slightly elevated border without scaling (Figure 2). The erosions were covered with a yellow-white exudate. There was mild nontender inguinal adenopathy. Biopsy specimens were taken from the margins of References 1. Mindel A. Cutaneous herpes simplex infection . Scand J Infect Dis. 1991;78: 47-52. 2. Gretzula J, Penneys NS. Complex viral and fungal skin lesions of patients with acquired immunodeficiency syndrome . J Am Acad Dermatol. 1987;16:1151-1154.Crossref 3. Penneys NS. Cutaneous signs of AIDS . Dermatol Clin. 1989;7:571-577. 4. Penneys NS, Hicks B. Unusual cutaneous lesions associated with acquired immunodeficiency syndrome . J Am Acad Dermatol. 1985;13:845-852.Crossref 5. Coopman SA, Johnson RA, Platt R, Stern RS. Cutaneous disease and drug reactions in HIV infection . N Engl J Med. 1993;328:1670-1674.Crossref 6. Goodman DS, Teplitz ED, Wishner A, et al. Prevalence of cutaneous disease in patients with acquired immunodeficiency syndrome (AIDS) or AIDS-related complex . J Am Acad Dermatol. 1987;17:210-220.Crossref 7. Siegal FP, Lopez C, Hammer GS, et al. Severe acquired immunodeficiency in male homosexuals, manifested by chronic perianal ulcerative herpes simplex lesions . N Engl J Med. 1981;305:1439-1444.Crossref 8. Crumpacker CS. Significance of resistance of herpes simplex virus to acyclovir . J Am Acad Dermatol. 1988;18:190-195.Crossref 9. Englund JA, Zimmerman ME, Swierkosz EM, et al. Herpes simplex virus resistant to acyclovir: a study in a tertiary care center . Ann Intern Med. 1990; 112:416-422.Crossref 10. Marks GL, Nolan PE, Erlich KS, Ellis MN. Mucocutaneous dissemination of acyclovir-resistant herpes simplex virus in a patient with AIDS . Rev Infect Dis. 1989;11:474-476.Crossref 11. King DH. History, pharmacokinetics, and pharmacology of acyclovir . J Am Acad Dermatol. 1988;18:176-179.Crossref 12. Epstein JB, Scully C. Herpes simplex virus in immunocompromised patients . Oral Surg Oral Med Oral Pathol. 1991;72:47-50.Crossref 13. Hardy WD. Foscarnet treatment of acyclovir-resistant herpes simplex virus infection in patients with acquired immunodeficiency syndrome . Am J Med. 1992; 92( (suppl) ):30-35.Crossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Dermatology American Medical Association

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Publisher
American Medical Association
Copyright
Copyright © 1996 American Medical Association. All Rights Reserved.
ISSN
0003-987X
eISSN
1538-3652
DOI
10.1001/archderm.1996.03890250091015
Publisher site
See Article on Publisher Site

Abstract

Abstract REPORT OF A CASE A 26-year-old white man with the human immunodeficiency virus (HIV) presented with a 5-month history of nonhealing and painful ulcerations in the groin and perirectal region. These areas had previously been treated with bacitracin zinc and polymyxin B sulfate (Polysporin ointment), fluconazole, doxycycline, acyclovir, and rifampin, none of which resulted in improvement of the erosions. Previous cultures from the area yielded diphtheroids, Staphylococcus epidermidis, and Enterococcus faecalis.The physical examination revealed a well-defined 4-cm erythematous erosion with a slightly raised margin present within the right inguinal fold extending onto the upper medial aspect of the right thigh and onto the scrotal sac (Figure 1). In the perirectal region, there was an 8×5-cm erythematous erosion with a similar slightly elevated border without scaling (Figure 2). The erosions were covered with a yellow-white exudate. There was mild nontender inguinal adenopathy. Biopsy specimens were taken from the margins of References 1. Mindel A. Cutaneous herpes simplex infection . Scand J Infect Dis. 1991;78: 47-52. 2. Gretzula J, Penneys NS. Complex viral and fungal skin lesions of patients with acquired immunodeficiency syndrome . J Am Acad Dermatol. 1987;16:1151-1154.Crossref 3. Penneys NS. Cutaneous signs of AIDS . Dermatol Clin. 1989;7:571-577. 4. Penneys NS, Hicks B. Unusual cutaneous lesions associated with acquired immunodeficiency syndrome . J Am Acad Dermatol. 1985;13:845-852.Crossref 5. Coopman SA, Johnson RA, Platt R, Stern RS. Cutaneous disease and drug reactions in HIV infection . N Engl J Med. 1993;328:1670-1674.Crossref 6. Goodman DS, Teplitz ED, Wishner A, et al. Prevalence of cutaneous disease in patients with acquired immunodeficiency syndrome (AIDS) or AIDS-related complex . J Am Acad Dermatol. 1987;17:210-220.Crossref 7. Siegal FP, Lopez C, Hammer GS, et al. Severe acquired immunodeficiency in male homosexuals, manifested by chronic perianal ulcerative herpes simplex lesions . N Engl J Med. 1981;305:1439-1444.Crossref 8. Crumpacker CS. Significance of resistance of herpes simplex virus to acyclovir . J Am Acad Dermatol. 1988;18:190-195.Crossref 9. Englund JA, Zimmerman ME, Swierkosz EM, et al. Herpes simplex virus resistant to acyclovir: a study in a tertiary care center . Ann Intern Med. 1990; 112:416-422.Crossref 10. Marks GL, Nolan PE, Erlich KS, Ellis MN. Mucocutaneous dissemination of acyclovir-resistant herpes simplex virus in a patient with AIDS . Rev Infect Dis. 1989;11:474-476.Crossref 11. King DH. History, pharmacokinetics, and pharmacology of acyclovir . J Am Acad Dermatol. 1988;18:176-179.Crossref 12. Epstein JB, Scully C. Herpes simplex virus in immunocompromised patients . Oral Surg Oral Med Oral Pathol. 1991;72:47-50.Crossref 13. Hardy WD. Foscarnet treatment of acyclovir-resistant herpes simplex virus infection in patients with acquired immunodeficiency syndrome . Am J Med. 1992; 92( (suppl) ):30-35.Crossref

Journal

Archives of DermatologyAmerican Medical Association

Published: Jan 1, 1996

References