PMC9282704_01
(a) Two ulcers with necrotic slough over the glans penis. (b) Photomicrograph of first biopsy showing acute inflammatory infiltrate and fibrinoid necrosis of vessels (x40). (c) Photomicrograph of repeat biopsy showing mixed inflammatory cell infiltrate (x40). (d) Healing ulcers showing healthy granulation tissue after treatment with immunomodulators
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F1
Glans penis had two well-defined tender, indurated ulcers with necrotic grayish-white slough, regular margins, undermined edges, erythematous border- measuring 3 cm x 2 cm and 0.5 cm x 0.5 cm [Figure 1a]. Skin biopsy [Figure 1b] showed acanthosis, fibrinoid necrosis in vessels, acute inflammatory cell infiltrate, and granulation tissue in the dermis along with necrotic debris. Dermis showed granulation tissue with dense mixed inflammatory infiltrate of neutrophils, lymphocytes, and occasional plasma cells; there is no evidence of vasculitis, epithelioid cell granuloma, Crohn's disease, or malignancy [Figure 1c]. Prednisolone was added for 6 weeks with a maximum of 40 mg daily with which he showed rapid improvement [Figure 1d].