Case for Diagnosis
Sudden-Onset Scrotal Ulcer
Úlcera escrotal aguda
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He reported painful swallowing, had a temperature of 38<span class="elsevierStyleHsp" style=""></span>°C, and denied ingestion of drugs or toxic substances, engagement in high-risk sexual practices, local injury, and application of topical products.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Physical Examination</span><p id="par0010" class="elsevierStylePara elsevierViewall">Physical examination revealed an ulcer of 30<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>25<span class="elsevierStyleHsp" style=""></span>mm with necrosis in the center and slightly erythematous edges located on the right side of the scrotum (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). There were no palpable lymph nodes in the groin area. Examination of the throat revealed extensive pharyngeal and tonsillar erythema.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Additional Tests</span><p id="par0015" class="elsevierStylePara elsevierViewall">Blood tests showed increased total leukocytes and acute phase reactants. Ultrasound examination of the soft tissue and Doppler ultrasound showed no evidence of epididymal or testicular abnormalities.</p><p id="par0020" class="elsevierStylePara elsevierViewall">Serology for viruses (human immunodeficiency virus, hepatitis B virus, parvovirus B19, cytomegalovirus, Epstein–Barr virus) and syphilis were negative. <span class="elsevierStyleItalic">Staphylococcus epidermidis</span> was isolated in a culture from the base of the ulcer, although this was interpreted as a probable case of contamination. The direct immunofluorescence study and culture for herpes simplex virus were negative.</p><p id="par0025" class="elsevierStylePara elsevierViewall">Biopsy of the edge of the ulcer showed a dense neutrophilic inflammatory infiltrate in the dermis, with a predominant perivascular distribution. Foci of neutrophil aggregates were seen in the walls of the small and medium-sized vessels, with no evidence of fibrinoid necrosis (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>).</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0030" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">What Is Your Diagnosis?</span></p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Diagnosis</span><p id="par0035" class="elsevierStylePara elsevierViewall">Juvenile gangrenous vasculitis of the scrotum.</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Clinical Course</span><p id="par0040" class="elsevierStylePara elsevierViewall">Once other potentially serious causes of scrotal ulceration had been ruled out, the lesion was treated daily with physiological saline solution and petrolatum-impregnated dressings to provide protection. The pharyngeal and tonsillar erythema disappeared in 5 days and the ulcer healed gradually, resulting in complete reepithelialization. No new lesions were detected at follow-up.</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Discussion</span><p id="par0045" class="elsevierStylePara elsevierViewall">Juvenile gangrenous vasculitis of the scrotum is a variant of scrotal gangrene with unique clinical and histopathological characteristics first described by Piñol et al.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> The etiology is unknown and the condition presents almost exclusively in healthy young adults. Pruritus and/or burning in the scrotal area precedes the appearance of 1 or several areas of cutaneous necrosis. The infection tends to be accompanied by an increase in body temperature with no clear source of infection. Pharyngeal and tonsillar infection is common in the preceding days or weeks. Blood tests reveal increased total leukocytes and acute phase reactants. Blood cultures are sterile and no microorganisms are isolated from the lesions. Tests for antinuclear antibodies are negative and evaluation of other parameters indicative of autoimmune response gives normal values. Histopathology shows an area of extensive epidermal necrosis accompanied by a dense inflammatory infiltrate consisting of neutrophils. These polymorphonuclear leukocytes can invade the vessel walls, and imaging techniques reveal leukocytoclasia, without fibrinoid necrosis, in the walls of the small blood vessels of the dermis. However, focal presence of fibrinoid necrosis does not rule out a diagnosis of juvenile gangrenous vasculitis of the scrotum.<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2–4</span></a> The condition resolves spontaneously in less than a month, although good hygiene and suitable dressings around the lesion can accelerate reepithelialization. Nonrecurrence is listed as a main diagnostic criterion for this condition. Differential diagnosis should include other causes of acute scrotal ulceration such as Fournier gangrene, Behçet disease, polyarthritis nodosa, herpes virus infections, primary syphilis, trauma-induced scrotal ulcers, dermatitis artefacta, pyoderma gangrenosum,<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> and cocaine consumption,<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> among others.</p><p id="par0050" class="elsevierStylePara elsevierViewall">In summary, we present the case of a rare and generally little-known entity that is significant for its benign course and clinical similarity to other causes of scrotal ulceration that have different therapeutic and prognostic implications.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:7 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Medical History" ] 1 => array:2 [ "identificador" => "sec0010" "titulo" => "Physical Examination" ] 2 => array:2 [ "identificador" => "sec0015" "titulo" => "Additional Tests" ] 3 => array:2 [ "identificador" => "sec0020" "titulo" => "Diagnosis" ] 4 => array:2 [ "identificador" => "sec0025" "titulo" => "Clinical Course" ] 5 => array:2 [ "identificador" => "sec0030" "titulo" => "Discussion" ] 6 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara">Please cite this article as: Pulido-Pérez A, et al. Úlcera escrotal aguda. Actas Dermosifiliogr. 2012;103:239–40.</p>" ] ] "multimedia" => array:2 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 713 "Ancho" => 950 "Tamanyo" => 185507 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Ulcer on the right side of the scrotum.</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 713 "Ancho" => 946 "Tamanyo" => 202855 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Hematoxylin–eosin, original magnification ×100.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:6 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "A propos de cinq observationes d’une forme particuliere de vascularite gangreneuse du scrotum" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "J. 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Chen" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1345/aph.1L487" "Revista" => array:6 [ "tituloSerie" => "Ann Pharmacother" "fecha" => "2009" "volumen" => "43" "paginaInicial" => "375" "paginaFinal" => "378" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19193577" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/15782190/0000010300000003/v1_201304241257/S1578219012001072/v1_201304241257/en/main.assets" "Apartado" => array:4 [ "identificador" => "6171" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Cases for Diagnosis" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/15782190/0000010300000003/v1_201304241257/S1578219012001072/v1_201304241257/en/main.pdf?idApp=UINPBA000044&text.app=https://actasdermo.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219012001072?idApp=UINPBA000044" ]
| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 138 | 10 | 148 |
| 2024 October | 962 | 68 | 1030 |
| 2024 September | 965 | 67 | 1032 |
| 2024 August | 1135 | 85 | 1220 |
| 2024 July | 893 | 62 | 955 |
| 2024 June | 706 | 93 | 799 |
| 2024 May | 756 | 58 | 814 |
| 2024 April | 576 | 72 | 648 |
| 2024 March | 582 | 63 | 645 |
| 2024 February | 599 | 64 | 663 |
| 2024 January | 651 | 74 | 725 |
| 2023 December | 734 | 65 | 799 |
| 2023 November | 528 | 58 | 586 |
| 2023 October | 356 | 77 | 433 |
| 2023 September | 315 | 64 | 379 |
| 2023 August | 281 | 42 | 323 |
| 2023 July | 311 | 85 | 396 |
| 2023 June | 277 | 60 | 337 |
| 2023 May | 249 | 57 | 306 |
| 2023 April | 244 | 42 | 286 |
| 2023 March | 151 | 50 | 201 |
| 2023 February | 144 | 61 | 205 |
| 2023 January | 198 | 65 | 263 |
| 2022 December | 234 | 67 | 301 |
| 2022 November | 102 | 90 | 192 |
| 2022 October | 50 | 70 | 120 |
| 2022 September | 39 | 102 | 141 |
| 2022 August | 25 | 102 | 127 |
| 2022 July | 22 | 108 | 130 |
| 2022 June | 36 | 126 | 162 |
| 2022 May | 224 | 84 | 308 |
| 2022 April | 254 | 53 | 307 |
| 2022 March | 242 | 82 | 324 |
| 2022 February | 236 | 77 | 313 |
| 2022 January | 236 | 119 | 355 |
| 2021 December | 193 | 103 | 296 |
| 2021 November | 231 | 98 | 329 |
| 2021 October | 185 | 166 | 351 |
| 2021 September | 127 | 166 | 293 |
| 2021 August | 232 | 172 | 404 |
| 2021 July | 195 | 176 | 371 |
| 2021 June | 188 | 180 | 368 |
| 2021 May | 92 | 200 | 292 |
| 2021 April | 89 | 366 | 455 |
| 2021 March | 103 | 206 | 309 |
| 2021 February | 90 | 169 | 259 |
| 2021 January | 52 | 145 | 197 |
| 2020 December | 54 | 181 | 235 |
| 2020 November | 42 | 169 | 211 |
| 2020 October | 69 | 154 | 223 |
| 2020 September | 41 | 132 | 173 |
| 2020 August | 47 | 186 | 233 |
| 2020 July | 44 | 147 | 191 |
| 2020 June | 53 | 190 | 243 |
| 2020 May | 44 | 224 | 268 |
| 2020 April | 56 | 158 | 214 |
| 2020 March | 36 | 21 | 57 |
| 2020 February | 3 | 21 | 24 |
| 2020 January | 4 | 35 | 39 |
| 2019 December | 8 | 33 | 41 |
| 2019 November | 4 | 245 | 249 |
| 2019 October | 0 | 262 | 262 |
| 2019 September | 8 | 256 | 264 |
| 2019 August | 4 | 231 | 235 |
| 2019 July | 2 | 153 | 155 |
| 2019 June | 13 | 142 | 155 |
| 2019 May | 1 | 230 | 231 |
| 2019 April | 0 | 188 | 188 |
| 2019 March | 2 | 91 | 93 |
| 2019 February | 0 | 50 | 50 |
| 2019 January | 2 | 60 | 62 |
| 2018 December | 2 | 34 | 36 |
| 2018 November | 1 | 0 | 1 |
| 2018 October | 3 | 0 | 3 |
| 2018 September | 20 | 71 | 91 |
| 2018 August | 0 | 145 | 145 |
| 2018 July | 0 | 125 | 125 |
| 2018 June | 0 | 99 | 99 |
| 2018 May | 0 | 89 | 89 |
| 2018 April | 0 | 56 | 56 |
| 2018 March | 13 | 68 | 81 |
| 2018 February | 203 | 73 | 276 |
| 2018 January | 189 | 43 | 232 |
| 2017 December | 208 | 57 | 265 |
| 2017 November | 156 | 41 | 197 |
| 2017 October | 201 | 49 | 250 |
| 2017 September | 192 | 49 | 241 |
| 2017 August | 199 | 50 | 249 |
| 2017 July | 150 | 45 | 195 |
| 2017 June | 126 | 60 | 186 |
| 2017 May | 109 | 44 | 153 |
| 2017 April | 102 | 20 | 122 |
| 2017 March | 97 | 28 | 125 |
| 2017 February | 103 | 47 | 150 |
| 2017 January | 112 | 32 | 144 |
| 2016 December | 175 | 20 | 195 |
| 2016 November | 167 | 16 | 183 |
| 2016 October | 200 | 45 | 245 |
| 2016 September | 313 | 35 | 348 |
| 2016 August | 227 | 41 | 268 |
| 2016 July | 130 | 43 | 173 |
| 2016 June | 18 | 15 | 33 |
| 2016 May | 10 | 20 | 30 |
| 2016 April | 7 | 27 | 34 |
| 2016 March | 11 | 25 | 36 |
| 2016 February | 11 | 1 | 12 |
| 2016 January | 9 | 23 | 32 |
| 2015 December | 10 | 1 | 11 |
| 2015 November | 10 | 26 | 36 |
| 2015 October | 17 | 19 | 36 |
| 2015 September | 14 | 13 | 27 |
| 2015 August | 16 | 7 | 23 |
| 2015 July | 132 | 16 | 148 |
| 2015 June | 107 | 10 | 117 |
| 2015 May | 165 | 11 | 176 |
| 2015 April | 142 | 14 | 156 |
| 2015 March | 133 | 13 | 146 |
| 2015 February | 87 | 20 | 107 |
| 2015 January | 133 | 10 | 143 |
| 2014 December | 103 | 13 | 116 |
| 2014 November | 117 | 10 | 127 |
| 2014 October | 147 | 13 | 160 |
| 2014 September | 155 | 11 | 166 |
| 2014 August | 230 | 23 | 253 |
| 2014 July | 255 | 21 | 276 |
| 2014 June | 245 | 15 | 260 |
| 2014 May | 265 | 18 | 283 |
| 2014 April | 210 | 11 | 221 |
| 2014 March | 157 | 13 | 170 |
| 2014 February | 117 | 36 | 153 |
| 2014 January | 143 | 22 | 165 |
| 2013 December | 172 | 27 | 199 |
| 2013 November | 112 | 31 | 143 |
| 2013 October | 109 | 25 | 134 |
| 2013 September | 102 | 13 | 115 |
| 2013 August | 70 | 34 | 104 |
| 2013 July | 30 | 33 | 63 |
| 2013 June | 16 | 34 | 50 |
| 2013 May | 19 | 15 | 34 |
| 2013 April | 21 | 20 | 41 |
| 2013 March | 23 | 17 | 40 |
| 2013 February | 52 | 8 | 60 |
| 2013 January | 180 | 7 | 187 |
| 2012 December | 45 | 4 | 49 |
| 2012 November | 1 | 1 | 2 |
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