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By Robert S. Levine, DO, and Stephen M.
Schleicher, MD
November 2004
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CASE:
A 51-year-old woman presents with the complaint of a painful
area on her buttocks near the gluteal fold. The rash arose
two days prior to consultation. She recalls having a similar
rash approximately two years ago, which spontaneously resolved.
She denies other symptoms including fever, malaise, and swollen
glands. Examination reveals grouped vesicles on an erythematous
base.
WHAT IS YOUR DIAGNOSIS?
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The diagnosis is infection with the herpes simplex virus. A
scraping from the base of a vesicle (Tzanck test) stained with
Giemsa would reveal multinucleated giant cells, and viral culture
would be positive. Most cases do not require clinical tests
and are diagnosed by the classic appearance. Genital herpes
is usually caused by the herpes simplex virus type 2 and occurs
in sexually active individuals. Symptoms may include pain, tenderness,
and itching. The duration of each episode will be shortened
by oral antiviral therapy with acyclovir, valacyclovir, or famciclovir,
which may also be used as chronic, suppressive therapy for those
who experience frequent episodes. |
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Dr. Levine is a family practice resident
at the Long Beach Medical Center in Long Beach, New York.
Dr. Schleicher is director of the DermDx Centers for Dermatology
of Northeastern Pennsylvania as well as Schleicher Dermatology
Associates in Bonita Springs, Florida. He is a clinical instructor
of dermatology at the Philadelphia College of Osteopathic
Medicine, at Kings College in Wilkes-Barre, Pennsylvania,
and at Arcadia University in Glenside, Pennsylvania. He is
also a member of the EMERGENCY MEDICINE editorial board.
Emerg Med 36(11):39-40, 2004
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