BMJ Case Reports Subject Collection: Sexual health

Nodular secondary syphilis in a woman [CASE-REPORT]

Glatz, M. — 2013-05-08

We report the case of a 21-year-old woman with symmetrically distributed, ulcerated nodules and plaques on the face, neck and arms. Initial differential diagnoses included pyoderma or sarcoidosis based on the clinical presentation and histopathology with non-caseating granulomas. After inefficient treatment with topical and systemic fusidic acid and steroids, we diagnosed nodular secondary syphilis owing to positive serology and immunohistochemical staining of Treponema pallidum in lesional skin. After treatment with benzathine penicillin, skin lesions improved and antibody titres declined significantly within 3 months. Nodular skin lesions in secondary syphilis are rare with 15 reported cases within the last 20 years. Furthermore, the granulomatous histology is often misleading. Our patient's case suggests that the physicians should be aware of syphilis as a possible differential diagnosis also in patients outside a high-risk population for sexually transmitted diseases and with an unusual clinical presentation.

Acquired urethral meatal stenosis: a rare sequel of an aggressive form of Behcet's disease [CASE-REPORT]

Ghosh, S. — 2013-04-29

Behcet's disease (BD) is characterised by the triad of recurrent oral and genital aphthous ulceration, skin lesions and ocular inflammation. This disease frequently affects other systems including neurological, locomotor, cardiac or vascular systems. Recurrent oral and genital aphthous ulcerations are the hallmarks of BD. We hereby report a case of rapidly evolving and aggressive form of BD in a young man presenting with extensive ulcerative lesions in orogenital region leading to obstructive uropathy resulting in acquired urethral meatal stenosis due to inflammatory activity.

Acute cervicitis and vulvovaginitis may be associated with Cytomegalovirus [CASE-REPORT]

Abou, M. — 2013-04-19

Cytomegalovirus (CMV) infection in immunocompetent hosts is generally asymptomatic or may present as a mononucleosic syndrome. Its association with acute cervicitis and vulvovaginitis has rarely been reported. A 24-year-old woman presented with pelvic pain, vulvodynia, abnormal vaginal discharge, burning with urination, fatigue, fever, vomiting and diarrhoea. The vulva and cervix were red with vesicular lesions on the cervix. Genital herpes simplex infection (HSV) was suspected and valacyclovir was given orally. However, serial viral cultures performed 7 weeks apart did not isolate HSV as suspected, but CMV was confirmed by immunofluorescence and early antigen research. Blood tests confirmed an acute CMV infection. Typical inclusions were found at histology. Symptoms resolved slowly with persistence of cervical lesions at 7 weeks from diagnosis. The frequency of CMV genital infection is probably underestimated. The infection is not always asymptomatic and might be confused with genital HSV infection. The clinical course is longer.

An unusual breast lump: osseous metaplasia [CASE-REPORT]

Joshi, M. — 2013-02-21

We present a rare case of osseous metaplasia in the breast with no other associated breast pathology. A 46-year-old HIV-positive lady presented to the breast clinic with new onset intermittent left-sided mastalgia. Clinical examination revealed an indeterminate mass in the left breast with palpable left axillary lymphadenopathy. Mammography and ultrasonography were suggestive of a possible malignancy, with the latter also detecting the presence of abnormal nodes in the axilla. An ultrasound-guided core biopsy of the breast lesion showed only hyalinised normal breast tissue on two occasions. Owing to the diagnostic uncertainty, the patient underwent a wire-guided excision biopsy of the breast lesion, with the final histology demonstrating bone matrix deposition with viable osteocytes within lacunae and associated osteoclasts with spindle cells, consistent with osseous metaplasia. A core biopsy of the axillary lymph nodes was normal. The patient was therefore reassured and discharged from the clinic.

Syphilis: a reversible cause of nephrotic syndrome [CASE-REPORT]

Handoko, M. L. — 2013-02-08

A patient in his late 30s presented with symptoms consistent with a nephrotic syndrome. Renal biopsy revealed membranous nephropathy. He also mentioned a spontaneous resolving rash' at his glans penis after unprotected intercourse. Therefore, he was tested for sexually transmitted diseases as a possible underlying cause of his nephrotic syndrome. Serology for syphilis was positive with high titres. After a single penicillin injection, there was fast and complete clinical recovery.

Syphilis: an ancient foe with multiple faces [CASE-REPORT]

Galveia, J. N. — 2013-01-29

Syphilis can have a multitude of different ophthalmological presentations. The authors present a case of a 59-year-old man, with complaints of bilateral blurred vision starting 6 months before. His best-corrected visual acuity was 20/20 in both eyes. Ophthalmological examination revealed bilateral superotemporal retinal oedema, extending to the superior macular region, with a white stippled discolouration of the corresponding retinal pigment epithelium. Laboratory work-up confirmed the diagnosis of syphilis. The patient was treated with penicillin G benzathine--2.4 million IU intramuscular weekly for 3 weeks. After treatment, a clinical improvement of the fundus lesions was observed along with a subjective improvement in visual function. Over a 12 month follow-up period, no recurrences have occurred.

Baseline-transmitted V106V/I/M non-nucleoside reverse transcriptase inhibitor resistance in HIV-1 subtype B infection [CASE-REPORT]

Sherman, E. — 2012-12-10

We report a case in which an antiretroviral therapy (ART)-naive patient diagnosed with HIV-1 subtype B presented with baseline genotype and phenotype resistance tests, confirming a V106V/I/M nucleoside resistance mutation. The V106V/I/M mutation represents a mixture of virus strains conferring resistance to the non-nucleoside reverse transcriptase inhibitor antiretrovirals efavirenz and nevirapine. V106M mutation is not often observed as a primary resistance mutation in patients infected with HIV-1 subtype B. The patient responded well to an ART regimen consisting of tenofovir-emtricitabine and raltegravir, achieving and maintaining an undetectable HIV RNA.

Laryngeal actinomycosis mimicking relapse of laryngeal carcinoma in a 67-year-old man [CASE-REPORT]

Ferry, T. — 2012-09-30

Description A 67-year-old man, a heavy smoker with a history of myocardial infarction, was followed up for a T3N2M0 laryngeal carcinoma. After primary chemotherapy, lateral pharyngo-laryngectomy was performed, followed by radiotherapy. Two-years later, mild dyspnoea at rest appeared and a relapse was suspected, as an ulcerated lesion with oedema was detected during endoscopy (figure 1A). Pathological examination of biopsies revealed cartilage suppurative necrosis with sulphur granules (figure 1C) and filamentous Gram-positive fungal-like pathogen (figure 1D). Actinomyces odontolyticus grew in bacterial cultures. Oral amoxicilline (6 g/day) was prescribed. One month later, the laryngeal lesion disappeared (figure 1B). The antimicrobial therapy was prolonged to 3 months. No relapse occurred during the follow-up. ...

Disseminated tuberculosis in pregnancy unknown to doctors in Western Europe case presentation: 'part of the routine study in infertility' [CASE-REPORT]

Jacquemyn, Y. — 2012-09-12

Tuberculosis in pregnancy is possibly increasing in Western Europe due to a higher incidence in immigrant women from endemic regions. Common in recent immigrants. Diagnosis during pregnancy is delayed because the disease is more frequently extra-pulmonary with few symptoms and western doctors are no longer familiar with signs and symptoms of tuberculosis. We report the case of a 28-year-old woman presenting in the 13th week of pregnancy with vaginal bleeding, respiratory symptoms including persistent coughing and fever since 1 month. Diagnosis was delayed because of doubts on taking x-rays during pregnancy, and only 6 days after admission chest x-ray and blood-cultures led to diagnose miliary tuberculosis. Despite tuberculostatic medication expulsion of an infected fetus and placenta occurred. Histological examination of the placenta confirmed tuberculosis in the placental tissue.

Can a perianal condyloma reach the pelvis? [CASE-REPORT]

Mendes-Bastos, P. — 2012-08-13

Description A 42-year-old MSM black male was admitted due to vigorous perianal bleeding. Physical examination revealed a 14x8 cm exophytic erythematous perianal tumour with a moist verrucous surface (figure 1, right). The lesion had its origin on the right anal verge, extending over 3 cm on the anal canal, as seen by anuscopy. There was no loco-regional lymphadenopathy upon palpation. Laboratory data revealed microcytic anaemia (Hg 3.9 g/dl) and pelvic MRI showed abnormalities on the external anal sphincter, right isquiorectal fossa fat and thickening of perianal skin. On histopathology, there was a papillomatous epithelial proliferation with viral cytopathic effect and no signs of atypia, in keeping with condyloma acuminatum (figure 2). Patient's history was remarkable for a 4-year HIV-1 positive serology (current viral load <50 copies/ml and CD4+ c ...