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JAMA Clinical Challenge
June 24, 2019

Oral and Penile Lesions in a Young Man

Author Affiliations
  • 1Department of Internal Medicine, State University of New York, Downstate Medical Center, Brooklyn
JAMA. 2019;322(4):357-358. doi:10.1001/jama.2019.7804

A 28-year-old man presented to the emergency department with diffuse oral lesions, fever, and nonproductive cough for 1 week. He was diagnosed with herpes simplex virus (HSV) and discharged home with acyclovir. Two days later, he returned with worsening oral lesions, painful phonation, poor oral intake, odynophagia, and new painful penile lesions. He denied any abdominal pain, diarrhea, rectal bleeding, weight loss, arthralgia, fatigue, vision changes, or skin rashes. He reported a similar episode of widespread oral lesions 18 months earlier that was less severe and self-resolving. He had no other medical conditions, took no medications, and was sexually monogamous with his wife, who was asymptomatic.