In , 1 cases of Lymphogranuloma venereum (LGV) were reported in 23 countries. M. Vall-Mayans, I. NoguerBrotes de linfogranuloma venéreo entre hombres homosexuales en Europa, Enferm Infecc Microbiol Clin, 24 (), pp. Request PDF on ResearchGate | Linfogranuloma venéreo: una causa emergente de proctitis en hombres homosexuales en Barcelona | Background and.
|Published (Last):||13 August 2011|
|PDF File Size:||6.74 Mb|
|ePub File Size:||12.79 Mb|
|Price:||Free* [*Free Regsitration Required]|
Lymphogranuloma venereum – “a clinical and histopathological chameleon? Associated professor – Bulgaria II M.
Lymphogranuloma venereum is an infection caused by a variety of the bacterium Chlamydia trachomatis. Both genital and extragenital manifestations of the disease can cause serious differential diagnostic difficulties, indirectly leading to progression and dissemination of the infection.
It also focuses on alternative therapeutic approaches, such as surgical excision at stage 1, that may lead to a vnereo outcome. It is not completely clear whether histopathological findings of lymphogranuloma venereum can reveal progression or changes in the course of the disease over time, as is the case in other diseases. We conclude that both clinical and histopathological observations in a larger number of patients are needed in order to further evaluate the findings presented in this article.
Chlamydia trachomatis; Lymphogranuloma venereum; Neoplasms; Surgery, plastic. According to the New York State Department of Health, the incidence of lymphogranuloma venereum LGV is highest among sexually active people living in tropical or subtropical climates, including some areas in the southern U.
Indeed, a recent Brazilian study coordinated by proctologists indicates that LGV has been diagnosed with increasing frequency in European countries, North America and Australia, mainly in men who have sex with men. The study also suggests an increasing incidence of LGV in Brazil. The diagnosis is often made serologically and by exclusion of other causes of inguinal lymphadenopathy or genital ulcers.
Even when LGV is suspected, investigations linogranuloma potentially co-existing sexually transmitted infections or other tumoral lesions venerro be undertaken. A year-old HIV-negative homosexual man complained of skin problems on his face and enlargement of cervical lymph nodes of three weeks duration Figure 1. He had been in Libya for three months before the onset of cutaneous manifestations. Clinical examination revealed an asymptomatic erythematous, erosive nodule on his right lower lip, approximately 12 mm in diameter, together with other two similar smaller lesions located on the ipsilateral cheek and zygoma.
The epidermis showed hyperkeratosis, with both ortho- and parakeratosis. Microabscesses could also be noted Figure 2. A microbial smear from lesional tissue was negative libfogranuloma Staphylococus aureus and Clostridium spp, and culture of lesional tissue was negative for Gonococcus Neisseria gonorrhoea. A Chlamydia smear from the urethra was also negative.
CT-Computer tomography of the neck area: Surgical excision of the affected lymph nodes was venereeo under local anaesthesia. Histopathological examination of the excised cervical lymph nodes was negative for metastatic tumor Figure 3. An year-old male had a two-month history of a progressively indurating papule of the gland penis, followed by ulceration.
The initial clinical suspicion lnfogranuloma of a cutaneous neoplasm Figure 4.
His history was positive for internal diseases, including a positive serology for rheumatoid arthritis, diabetes mellitus type II, glaucoma, heart failure status after bypass interventionand hypertension. The patient’s systemic medication included: A bone marrow biopsy showed plasma cells and gammopathy of uncertain significance.
Skin biopsy showed lymphocytic infiltrates with some eosinophils Figure 5. Immunohistochemically, linnfogranuloma was evidence of a chronic histiocytic macrophagic and fibrosing balanitis. Direct immunofluorescence studies were negative. Serologies for Infectious Diseases.
An initial consideration of skin cancer is not unreasonable in patients such as those discussed above, since clinical findings can be quite similar and histopathology is not always conclusive. The personal data in case 1 homosexuality and a recent time spent in Libya provides the clinician important linfogranuuloma and enhances the differential diagnosis by raising the possibility of rare and atypical cutaneous manifestations venefeo tropical and subtropical infections, such as LGV.
The enlarged lymph nodes in the cervical area could have been mistaken for locoregional metastases patient 1. The lesion in the infralabial area was removed in toto and the defect closed by single skin sutures.
As a supporting procedure, extirpation of single lymphatic nodes from the submandibular area was performed, and histopathological findings were identical. ilnfogranuloma
The exclusion of squamous cell carcinoma in patient 1 was of prime importance for the patient Figure 2. However, microscopic findings yielded surprising results: A rare manifestation of cutaneous leishmaniasis was excluded by PCR methodology. The cause of the hepatosplenomegaly, discovered by ultrasonography, remained unclear; the patient’s hepatic parameters were normal, arguing against vehereo possibility of an infectious etiology.
In addition to the good therapeutic results achieved by systemic medication, surgical excision of the entire lesion quickly led to full remission patient 1.
An excellent cosmetic effect was also achieved in the facial area Figure 3. Evidently, LGV is a disease that, within the socalled initial papule or stage 1a, can also be surgically treated. It is assumed that each stage of LGV has a different clinical and histopathological morphology.
The ulcerative genital form of LGV presented in case 2 is not characteristic of stage 1b, in which the ulcerations are mainly superficially located and lack fibrous coatings Figure 4. The patient was hospitalized because of linrogranuloma ulcerated tumor in the genital area.
Such a presentation, in an year-old patient sexually inactive, according to the clinical history is quite unusual. Due to the positive serology for Chlamydia trachomatissystemic therapy with doxycycline was instituted, leading to complete remission Figure 6. The Kappa type paraproteinemia found in this patient could suggest a disorder of the cutaneous microcirculation due to sedimentation of paraproteins combined with thrombocytes, erythrocytes, and fibrinogen in the form of cryoglobulins and cryofibrinogen.
However, in that case, clinical remission would not have been achieved with antibiotic therapy within weeks, but possibly with therapy directed towards hemodilution or vasodilatation. Indirectly, the diagnosis of a specific form of paraproteinemia could not be confirmed. The critically increased values of IgM serology do not eliminate the possibility of a localized, superinfected, macerated, genital form of varicella-zoster viral infection.
However, the non-specific histology eliminates the diagnosis of zoster involving the genital area and minimizes the critical positive values of IgM with respect to VZV infection. In addition, the negative immunofluorescence on lesional tissue argues against an immunologically initiated lesion within the framework of seropositive, active rheumatoid arthritis. The positive serology with respect to Chlamydia trachomatis and the rapid response to antimicrobial therapy indisputably lead to the interpretation of a rare form of LGV infection.
There was a problem providing the content you requested
The question of whether histopathological findings in this LGV-suffering patient could evolve to an image similar to that of other granulomatous diseases, such as pyoderma gangrenosum, remains unanswered. After a detailed analysis of all the bibliographic sources, we cannot entirely exclude the hypothesis that histopathological findings in LGV-patients can also evolve, in concert with the venero findings. At the acute stage case 1neutrophilic infiltrates prevail; at the subacute stage, venerdo macrophages most likely predominate case 2whereas at the chronic stage, granulomatous infiltrates probably prevail.
The role of dermatosurgery linforanuloma an important supporting method at the initial stages of this disease is evaluated. This shared finding is probably specific to the subacute stages of this disease. We do not exclude the possibility that an ulcerating balanitis could be generated within the context of seropositive, active rheumatoid arthritis, which is frequently able to initiate nonspecific skin and mucosal ulcerations.
In that case, partial improvement could in theory be achieved through the anti-inflammatory and immunomodulatory effects of the antibiotic doxycycline.
Lymphogranuloma venereum of the penis mimicking clinically gangrenous pyoderma and presenting histologically as macrophagocytic-histiocytic balanitis. Uncommon Extragenital Form of Lymphogranuloma venereum: Pyoderma gangrenosum in Crohn’s disease – The role of immunologic parameters and histological data in diagnosis and differential diagnosis.
Approved by the Advisory Board and accepted for publication on All the contents of this journal, except where linflgranuloma noted, is licensed under a Creative Commons Attribution License. Services on Demand Journal. Other complementary exams A microbial smear from lesional tissue was negative for Staphylococus aureus and Clostridium spp, and culture of lesional tissue was kinfogranuloma for Gonococcus Neisseria gonorrhoea.
Other Diagnostic Studies Roentgenography Rx: Treatment and Outcome Surgical excision of the affected lymph nodes was performed under local anaesthesia. Linfogranuloam findings A bone marrow biopsy showed plasma cells and gammopathy of uncertain significance. IgG positive – 4. Rio Branco, 39 How to cite this article.