{
  "abstract": "A 46-year-old man was admitted with suspected mpox (monkeypox). He reported unprotected sex with an asymptomatic man 2 weeks ago. Three days before admission, he had consulted a dermatologist for maculopapular lesions on his penis accompanied by mild itchiness and pain, without fever or other symptoms. He had been prescribed topical podophyllotoxin for suspected condyloma. He had documented the evolution of skin lesions with a series of photos, which showed black maculopapular changes on the penis corpus (figure 1). On admission, physical examination revealed black maculopapular lesions on the penis corpus and an ulcer on the glans (a broken vesicle). Regional lymph nodes were not enlarged. The throat and anal areas showed no abnormalities. Laboratory tests revealed elevated alanine aminotransferase (60 U/L; normal range 4–50 U/L) and gamma-glutamyl transferase (169 U/L; normal range 15–73 U/L). A urinalysis revealed no abnormalities. An abdominal ultrasound showed liver steatosis and mild splenomegaly (126 mm in length; normal ≤120 mm). Additional STI test results included negative HIV antigen/antibody, anti-HCV antibodies, HBsAg, anti-HBc, anti-HBs and RPR. Urinary chlamydia and gonorrhoea nucleic acids were not detected (Xpert CT/NG Test, Cepheid). Skin scrapings were twice negative for mpox DNA (Viasure Monkeypox Virus Real Time PCR Detection Kit). Further scrapings were tested for HSV and VZV DNA (Bosphore Vesicular Rash Panel Kit), confirming VZV infection. As the penile lesions had all scabbed, and there were no fresh lesions, acyclovir was not initiated. Sacral herpes zoster may cause ulcers on the penis and scrotum (dermatomes S2 and S3). It accounts for less than 3% of genital ulcers, and a high index of suspicion is required.1 2",
  "authors": [
    {
      "affiliations": [
        "Department of Adults’ Infectious Diseases, Medical University of Warsaw, Warsaw, Poland",
        "Hospital for Infectious Diseases in Warsaw, Warsaw, Poland"
      ],
      "name": "Carlo Bieńkowski"
    },
    {
      "affiliations": [
        "Department of Adults’ Infectious Diseases, Medical University of Warsaw, Warsaw, Poland",
        "Hospital for Infectious Diseases in Warsaw, Warsaw, Poland"
      ],
      "name": "Agata Skrzat-Klapaczyńska"
    },
    {
      "affiliations": [
        "Department of Adults’ Infectious Diseases, Medical University of Warsaw, Warsaw, Poland",
        "Hospital for Infectious Diseases in Warsaw, Warsaw, Poland"
      ],
      "name": "Agnieszka Bednarska"
    },
    {
      "affiliations": [
        "Department of Adults’ Infectious Diseases, Medical University of Warsaw, Warsaw, Poland",
        "Hospital for Infectious Diseases in Warsaw, Warsaw, Poland"
      ],
      "name": "Justyna D Kowalska"
    }
  ],
  "title": "Genital lesions of unusual aetiology in a male patient: case report",
  "uid": "7dc43df0-6c1d-5382-9142-8bc6899d70c9"
}