ALL THAT IS GENITAL IS NOT VENEREAL
Unusual cases with lesions on genitals
Genital disease (GD) has a broad spectrum. Though sexual transmission obviously plays a major role in its pathogenesis, many diseases with genital presentation are not sexually transmitted diseases (STD) but due to strong clinical resemblance cause a lot of diagnostic confusion and therapeutic misadventures. We report 4 such cases.
Case 1 and 2 A 35 yr old female presented with recurrent attacks of itchy, painful lesions over the genitals along with musculo-articular symptoms. On examination there were classical “knife cut ulcers” over the labia, perianal areas and inframammary folds.
Another 26 year old unmarried female presented with vulvar lesions. Indurated tender swelling, ulceration of the vulva, violaceous plaques with edoema were present.
Histopathology showed epitheloid cell granuloma with occasional Langhans giant cells. Clinicopathological correlation clinched both cases as Metastatic Crohn’s disease which responded to a course of oral metronidazole and corticosteroids.
Case 3 A young male presented with penile swelling, multiple discharging ulcers since 2 months. There was distortion of the shape and multiple shallow necrotic ulcers on the shaft of the penis with phimosis. Non- tender right inguinal lymphadenopthy. Biopsy showed multiple tuberculoid granulomas. Mantoux test was strongly positive with high ESR suggesting Genital Tuberculosis. The patient was started on AKT. 3 weeks later ulcers healed with destruction of overlying skin.
Case 4 A 56 year old married male came with raised lesions and a glazed whitish discolouration of glans penis with phimosis and thinning of urinary stream.
Biopsy revealed atypical undifferentiated cells and horn pearls. Imprint cytology and FNAC were done and a final diagnosis of Squamous Cell Carcinoma was made which required partial amputation of penis.
- genital tuberculosis
- metastatic crohn‘s disease
- squamous cell carcinoma