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Željko P. Mijušković, Lidija Kandolf Sekulović and Radoš D. Zečević

Abstract

Molluscum contagiosum is a very common, benign, often self-limiting skin disease caused by Molluscum contagiosum virus, member of the poxvirus family. Genital ulcers in HIV positive women are usually acute or subacute, mostly idiopathic or aphtous. Sixty percent of cases are caused by herpes simplex virus syphilis or chancroid. We present a 31-yearold woman with a 2.5 month history of vulval ulceration and a several month history of molluscum contagiosum in the pubic region, neck and face. After she was admitted to our department, the patient underwent physical examination using enzyme-linked immunosorbent assay, and an immunoblot test for HIV 1/2. Both tests were positive. Thereafter, the patient was referred to an infectologist who recommended application of 5% imiquimod cream 3 times per week for molluscum contagiosum and acyclovir 3x400 mg/day. Considering that there are more accepted indications for HIV testing, we agree with other authors that all adults with molluscum contagiosum or chronic genital ulceration should be tested for HIV serology.

Open access

Milan Bjekić and Kiro Ivanovski

Abstract

Oral lesions are described in all stages of syphilis, except in the latent stage. During the secondary stage of infection, oral lesions, saliva and blood of infected person are very contagious. The aim of this case report was to point to the secondary syphilis in differential diagnosis of oral diseases.

A 30-year-old homosexual man presented with a three-week history of a painless verrucous lesion on his lower lip. Physical examination revealed a hypertrophic painless papillomatous lesion on the lower lip. The lesion was partly split with peripheral fissures. There were no generalized lymphadenopathies and no evidence of systemic disease. Further examination showed no other mucous membrane or cutaneous lesions elsewhere on the body. The external genitalia were normal. The patient was HIV-negative and otherwise healthy. A review of his medical history was significant for previous well documented treatment of anal chancre, which was successfully commenced at our Institute in 2010. It also revealed a history of a single unprotected receptive oral sex with an unknown partner 3 months before the onset of lesion. The diagnosis of condyloma latum on the lower lip was considered on clinical grounds. Laboratory findings, including complete blood count and blood chemistry were within normal limits. The VDRL (venereal disease research laboratory) test was positive with a titre of 1 : 128. Treponema pallidum hemagglutination assay (TPHA) was positive. HIV serology was non-reactive.

The final diagnosis of solitary condyloma latum on the lower lip, as the only sign of secondary syphilis, was confirmed by positive results of routine serologic tests for syphilis. The patient was diagnosed with secondary syphilis and treated with a single intramuscular injection of benzathine penicillin, 2.4 million units. The lesion regressed completely within 2 weeks. Three months later the VDRL titer had fallen to 1 : 8 and HIV serology remained negative.

Polymorphic oral manifestations in syphilis indicate that this disease should not be overlooked in the differential diagnosis of not only benign, but even malignant oral lesions.

In conclusion, as far as the world literature available to us is concerned, this would be the first report of isolated solitary condyloma latum on the oral lip that, in the absence of any other clinical signs or symptoms of the disease, led to the diagnosis of secondary syphilis.

Open access

Olga Vlaov-Žarkov, Nada Vučković and Marina Jovanović

Abstract

Granulomatous rosacea is considered to be the only true variant of rosacea. Diascopy of larger lesions often reveals apple-jelly nodules, indicating their granulomatous histology. Other signs and symptoms of rosacea are not required to make a diagnosis of granulomatous rosacea. The response to treatment may be slow, which must be the most important consideration for both the clinician and the patient. We present an otherwise healthy 62-year-old non-atopic woman with a 15-year history of episodic facial flushing, often accompanied by a burning sensation without sweating. Exclusively affecting the face, lesions had a high tendency to spread each year. The patient was a lifelong non-smoker. A seller on the local market, she spent most of her time outdoors. She had no positive family history of rosacea. At the time of presentation, she was not taking any medications, except for topical neutral creams. Multiple reddish-brown papules without comedones, associated with telangiectasia were scattered over the erythematous background on the chin, forehead, cheeks, nose, glabella and eyelids, while small pustules clustered over the eyelids. The nasolabial folds, neck and ears were not affected. There was neither lymphadenopathy, nor ocular involvement. Based on the history, physical, laboratory and other relevant investigations including histopathology, the diagnosis of granulomatous rosacea was established. The therapy was conducted with topical azelaic acid 20% cream, twice daily for six months. Clinical evaluation was done every 14 days during the first month, and once monthly during the next five months. Affter two weeks, there was a significant decrease in the mean inflammatory lesion count. At the end of the therapy, telangiectasia and facial erythema almost disappeared. There were no side effects. Apart from several short episodes of erythema, during the five-year-long follow-up, there were no other signs of the disease. In conclusion, azelaic acid 20% cream may be an effective and safe treatment option for some patients with granulomatous rosacea.