PMC5360951_01
Appearance of tumorous lesions on the scrotum and perineum on admission.
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Physical exam was unremarkable except for three exophytic, nontender nodular lesions, about 1-2 cm in diameter, along the left side of the scrotum and a 5 cm in diameter mass in perineal region (Figure 1).
Histological sections of the lesion showing acute inflammatory and lymphoplasmacytic infiltrate in the dermis (hematoxylin-eosin (HE)), original magnification x40).
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The biopsy specimen revealed an ulcerated epidermis with an associated acute inflammation and prominent lymphoplasmacytic infiltrate (Figure 2).
(a) Histopathologic appearance showing epithelial cell with viral inclusions. (b) Histopathologic appearance showing multinucleated cells (HE, original magnification x400).
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Along the base of the ulceration were epidermal cells demonstrating viral cytopathic changes and multinucleated giant cells (Figures 3(a) and 3(b)).
Cells from the biopsy specimen showing positive immunostaining for HSV-2 (a) and HSV-1 (b) (original magnification x400).
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These cells stained positively with HSV-1 and HSV-2 immunostains (Figures 4(a) and 4(b)).
Appearance of pseudotumoral lesions on scrotum (a) and perineum (b) 11 days after starting leflunomide.
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The patient received 23 days of foscarnet, 14 days of topical imiquimod, and 11 days of leflunomide with approximately 80% reduction in the size of the perineal lesion compared to the size at the time of hospital admission (Figure 5).