MEDizzy - A 27-year-old man who recently returned from Southeast Asia

Feed Library Learning Discuss Leaderboard Journal

Infections due to Neisseria and others

A 27-year-old man who recently returned from Southeast Asia presents to your clinic for evaluation of painful swelling of the left groin, fever, chills, headaches, and arthralgias. On physical examination, his temperature is 100.6° F (38.1° C), and matted, fluctuant, suppurative left inguinal lymphadenopathy is noted. The overlying skin is inflamed. LGV is diagnosed by complement fixation assay, and you treat the patient with doxycycline. If the patient had gone untreated, which of the following complications could NOT develop?

ExplanationLGV is a sexually transmitted disease caused by C. trachomatis. The disease begins with an isolated, transient genital, rectal, or oral lesion; suppurative regional lymphadenopathy then occurs. Although the disease is rare in the United States, it is endemic in many parts of the world, including Africa, Asia, South America, and the Caribbean. The primary lesion is often a painless genital papule or vesicle that usually heals without scarring. From this primary site, the infection spreads to regional lymph nodes; approximately 2 to 6 weeks after the primary infection, lymphadenopathy develops. Femoral and iliac lymph nodes enlarge progressively and become matted, fluctuant, and often suppurative, forming fistulas to the skin. In addition to lymphadenopathy developing, fever, chills, headache and meningismus can develop. The diagnosis is made serologically with complement fixation or microimmunofluorescence testing. Treatment consists of doxycycline, 100 mg b.i.d. for 21 days. If untreated, patients can develop genital elephantiasis as a late complication; aseptic meningitis; encephalitis; and penile fistulas. Chancroid is a sexually transmitted disease caused by Haemophilus ducreyi and is not a complication of LGV; however, chancroid must be included in the differential diagnosis of patients with genital ulcers and lymphadenopathy.