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LETTER TO THE EDITOR |
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Year : 2013 | Volume
: 6
| Issue : 4 | Page : 490-491 |
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Lymphogranuloma venereum: Saxophone penis with bilateral groove sign
Gaurang Gupta, Divyashree Ramnathpur Achar, Bhumika Bhandari
Department of Dermatology, Shri Dharmasthala Manjunatheswara College of Medical Sciences and Hospital, Sattur, Dharwad, Karnataka, India
Date of Web Publication | 17-Sep-2013 |
Correspondence Address: Gaurang Gupta Department of Dermatology, OPD No. 10, Shri Dharmasthala Manjunatheswara Medical College, Sattur, Dharwad - 580 009, Karnataka India
Source of Support: None, Conflict of Interest: None | Check |
DOI: 10.4103/0975-2870.118304
How to cite this article: Gupta G, Achar DR, Bhandari B. Lymphogranuloma venereum: Saxophone penis with bilateral groove sign. Med J DY Patil Univ 2013;6:490-1 |
Sir,
Lymphogranuloma venereum (LGV) is a bacterial sexually transmitted disease (STD) caused by Chlamydia trachomatis serovar L 1 , L 2 , L 3 . Its clinical presentation varies from primary lesion to genito-ano-rectal syndrome. Inguinal lymph nodes are commonly involved. It is less common than other STDs and, recently, a decrease trend in its incidence was reported. [1]
A 45-year-old married male patient presented with bilateral painful inguinal swellings and twisted penis since 6 months. Following initial painful inguinal swelling, he gradually developed swelling of scrotum and penis with thickening of the overlying skin over a period of few weeks. Patient had a past history of ulcerative lesion over penis 8 months back, which healed without any treatment. The patient gave history of repeated unprotected sexual contact with multiple partners. There was no history of difficulty in defecation, constipation, or bleeding per rectum.
On examination, oval, lobulated swellings were present in the inguinal folds and in the femoral region, bilaterally. The lesions were adherent to the overlying skin and fixed to the tissues. The enlarged inguinal and femoral lymph nodes were separated by a depression on both sides. [Figure 2] Elephantiasis of penis and scrotum was present. The penis was hard and twisted, giving rise to the so-called "saxophone" penis. [Figure 1] Per rectal examination was normal.
On investigations, hemoglobin level, total and differential leukocyte counts, total serum protein, albumin/globulin ratio, blood sugar, Mantoux test, chest X-ray, and ultrasound of the abdomen were normal. The patient was seronegative for HIV-I and II. Midnight peripheral blood smears for microfilariae were negative. The complement fixation test and microimmunofluorescence test for LGV could not be done because of non-availability of the facilities in our institution. A diagnosis of LGV was made based on the history and clinical features. The patient was started on doxycyline (100 mg) BD and was called for review after a week. But the patient was lost to follow-up.
LGV, climatic bubo, or tropical bubo is a infection of lymphatic channels, which is transmitted by sexual contacts and close nonsexual contact. [1] It is a chronic disease characterized by primary stage, secondary stage (inguinal bubo), and tertiary stage (ano-genital-rectal). [2] Primary lesions may be papules, nodules, or ulcerative type lesions, which heal without scarring and are often unnoticed by the patient. [3] Secondary stage is characterized by inflammatory swelling of the inguinal lymph nodes and their corresponding tributaries and branches. [4] It is predominantly seen in males and is unilateral in two-third of cases. [5] In 20% cases "groove" sign of Greenblatt is present, which is pathognomonic of LGV. [6] Tertiary stage is characterized by genital, anal, and rectal involvement. Penile and scrotal elephantiasis is invariably secondary to a chronic bilateral inguinal adenitis. Due to elephantiasis, penis may virtually be hard and may get twisted to form the so-called "saxophone" penis. [3] Late complications of the male inguinal syndrome are rare. [7] Elephantiasis of the penis and scrotum characterised by infiltrative, ulcerative, and fistular lesions occurs in approximately 4% of cases. [8]
This case is being reported because of presence of bilateral "groove" sign and "saxophone" penis, which are rare complication of LGV.
References | | |
1. | Khanna N, Pandhi RK, Lakhanpal PS. Changing trends in sexually transmitted disease: A hospital based study from Delhi. Indian J Sex Transm Dis 1996;17:79-81. |
2. | Faro S. Lymphogranuloma venereum, chancroid, granuloma venereal. Obstet Gynecol Clin North Am 1989;16:517-30. [PUBMED] |
3. | Rajam RV, Rangiah PN. Lymphogranuloma venereum. Indian J Dermatol 1955;4:1-65. |
4. | Perine PL, Osoba AO. Lymphogranuloma venereum. In: Holmes KK, Mardh PA, Sparling PF, Wiesner PJ, editors. Sexually transmitted disease. 2 nd ed. New York: McGraw-Hill; 1990. p. 195-204. |
5. | Becker LE. Lymphogranuloma venereum. Int J Dermatol 1976;15:26-33. [PUBMED] |
6. | Schachter J. Lymphgranuloma venereum and other non-ocular Chlamydia trachomatis infections. In: Hobson D, Holmes KK, editors. Nongonococal urethritis and related infections. Washington: American Society for Microbiology; 1977. p. 91-7. |
7. | Rothenberg RB. Lymphogranuloma venereum. In: Freedberg IM, Eisen AZ, Wolff K, editors. Fitzpatrick's dermatology in general medicine. New York: McGraw Hill; 1999. p. 2591-4. |
8. | Hopsu-Havu VK, Sonck CE. Infiltrative, ulcerative and fistular lesions of the penis due to lymphoganuloma venereum. Br J Vener Dis 1973;49:193. [PUBMED] |
[Figure 1], [Figure 2]
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