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First case of “bubonulus” in L2 lymphogranuloma venerum
  1. Nathalie Spenatto4,
  2. Serge Boulinguez1,
  3. Bertille de Barbeyrac2,
  4. Roland Viraben3
  1. 1CIDDIST Hôpital La Grave, Toulouse, France
  2. 2Service de Bacteriologie, National Reference Centre of Chlamydia Infection, Bordeaux, France
  3. 3Service de Dermatologie, Toulouse, France
  4. 4CIDDIST Hôpital La Grave, Place Lange, 31059 Toulouse Cedex 9, France
  1. Correspondence to:
 Dr Nathalie Spenatto
 CIDDIST Hôpital La Grave, Place Lange, 31059 Toulouse Cedex 9, France; spenatto.n{at}


Since 2003, an ongoing lymphogranuloma venereum (LGV) proctitis outbreak has been reported in industrialised countries with a new variant designated L2b. Only men who have sex with men (MSM) are affected and most are HIV co-infected; delayed or incorrect diagnoses are frequent. We report a rare clinical case of LGV primary stage called “bubonulus” with penile adenopathy and secondary local acute lymphoedema in an MSM seropositive man. This is the first case described of this clinical presentation with a L2b genovar strain, occurring immediately after use of a sex toy. It suggests that this presentation is favoured by host immunity and behavioural factors. These factors may also play a part in the new outbreak of LGV.

  • HAART, highly active antiretroviral therapy
  • LGV, lymphogranuloma venereum
  • MSM, men who have sex with men
  • PCR, polymerase chain reaction
  • sexually transmitted disease
  • lymphogranuloma venereum
  • bubonulus
  • chlamydia trachomatis
  • penile adenopathy

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  • NS was responsible for clinically managing the patient, reviewed the literature, and wrote the manuscript; SB clinically managed the patient and reviewed the manuscript; BB was responsible for the laboratory diagnosis; RV is head of Department of Dermatology and Venereology and critically commented on the manuscript.

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