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December 2003

A 63-Year-Old Man With Chronic Penile Ulcers—Diagnosis

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Arch Dermatol. 2003;139(12):1647-1652. doi:10.1001/archderm.139.12.1647-a

Initial outside microscopic examination revealed an ulcer with dermal necrosis, fibrosing granulation tissue, and foci of a granulomatous infiltrate composed of mononucleated and multinucleated histiocytes as well as numerous neutrophils and plasma cells (Figure 2). Special stains for bacteria, mycobacteria, spirochetes, and fungi were negative, as were immunohistochemical studies for herpesvirus. There was no evidence of hematologic clonality. As bacterial, mycobacterial, fungal, and viral cultures from the incisional biopsy specimen were all negative, a tentative diagnosis of pyoderma gangrenosum was made, and the patient was treated with prednisone (1 mg/kg per day), cyclosporine (4 mg/kg per day), and clofazimine (100 mg/d), with no significant improvement in the ulcer. The findings of extensive laboratory evaluation; computed tomography of the chest, abdomen, and pelvis; and colonoscopy were unremarkable. Serologic tests were negative for hepatitis and and human immunodeficiency virus. The results of rapid plasma reagin and fluorescent treponemal antibody tests and gonococcal and chlamydial DNA probes were also negative.

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