Painful inguinal swelling
Author:
Valerie Norton, MD
Affiliations:
Assistant Professor, Department of Emergency Medicine
Vanderbilt University Medical Center, Nashville, TN (VN)
Chief complaint:
Painful inguinal swelling
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History of present illness:
A 24-year old man presents
to the emergency department (ED) with four days of painful inguinal
swelling. He denies noticing any other genital lesions or ulcers
and denies penile discharge, fever, and dysuria. He admits to
engaging in unprotected sex with multiple female partners. He
was treated three months prior for urethritis, receiving antibiotics
to treat both Neisseria gonorrhea (GC) and Chlamydia
trachomatis (chlamydia) infections. He had a negative HIV
test at that time. He is otherwise healthy.
Physical examination:
The patient is in no distress
and has normal vital signs. Physical exam is normal with the
exception of the genitalia and the left inguinal adenopathy as
seen in the figure 1. There are multiple, enlarged left inguinal
lymph nodes which are matted, tender, and centrally fluctuant.
There are a few small, nonulcerative, excoriated papules on the
scrotum, pubis, and right inner thigh. The exam reveals no ulcers,
chancres, vesicles, warts, discharge, or other genital lesions.
Laboratory:
Urinalysis is negative. Penile cultures
are taken for GC and chlamydia. Blood is sent for RPR and lymphogranuloma
venereum (LGV) titers.
The patient course, diagnosis and discussion
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