Letter to the Editor
Lymphogranuloma venereum. Case report and management update
Linfogranuloma venéreo. Manejo actualizado a propósito de un caso
F.J. Melgosa Ramos
, E.M. Sánchez-Martínez
Corresponding author
Servicio de Dermatología, Hospital Universitario Doctor Peset, Valencia, Spain
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Manejo actualizado a propósito de un caso" "tienePdf" => "es" "tieneTextoCompleto" => "es" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "245" "paginaFinal" => "246" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Lymphogranuloma venereum. Case report and management update" ] ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figura 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 366 "Ancho" => 1250 "Tamanyo" => 57698 ] ] "descripcion" => array:1 [ "es" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">A) Lesión ulcerosa, indurada e indolora en el pene. B) Bubón inguinal derecho, blando y doloroso.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "F.J. 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Case report and management update" "tieneTextoCompleto" => true "saludo" => "Dear Editor," "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "245" "paginaFinal" => "246" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "F.J. Melgosa Ramos, E.M. Sánchez-Martínez" "autores" => array:2 [ 0 => array:4 [ "nombre" => "F.J." "apellidos" => "Melgosa Ramos" "email" => array:1 [ 0 => "javimelgo2017@gmail.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "E.M." "apellidos" => "Sánchez-Martínez" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Servicio de Dermatología, Hospital Universitario Doctor Peset, Valencia, Spain" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Linfogranuloma venéreo. Manejo actualizado a propósito de un caso" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 366 "Ancho" => 1250 "Tamanyo" => 57698 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">(A) Painless, indurated, ulcerative penile lesion. (B) Soft and painful right inguinal bubo.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Despite the wide variety of medical-surgical disease that urologists face daily, there are certain inguinal-genital conditions with which they may be less familiar and yet may find useful to identify and manage.</p><p id="par0010" class="elsevierStylePara elsevierViewall">To this end, we present the case of a 24-year-old male diagnosed in our service with lymphogranuloma venereum (LGV). He consulted after a hard and painless ulcerative lesion on the penis, of 3 weeks of evolution (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>A), which a few days later was accompanied by the appearance of painful right inguinal lymphadenopathy (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>B). He contracted the disease from a new partner, of Brazilian origin. The diagnosis was confirmed by serology test and other sexually transmitted infections were ruled out. Treatment was instituted with doxycycline at a dose of 100 mg (mg) every 12 h for 3 weeks with improvement of the picture from the first week.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">LGV is a rare cause of genital ulcer caused by <span class="elsevierStyleItalic">Chlamydia trachomatis</span> (<span class="elsevierStyleItalic">C. trachomatis</span>) serovars L1 L2 L3<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a>. It is an infection restricted almost exclusively to developing countries in Africa, Asia and South America, while in Europe its incidence is anecdotal and typically presents as anorectal infection in men who have sex with men<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a>. The genital form is less common and can be mistaken with other causes of painless ulcerative lesions on the genitals, such as syphilis; however, the evolution of the picture, together with epidemiological findings from the clinical history, are indicative in the diagnostic process. The incubation period ranges from 1 to 4 weeks after contact. Subsequently, the clinical manifestations occur in 3 stages: in the primary stage, one or more papules appear, usually painless and indurated, which evolve into ulcers. Between 2 and 6 weeks later, in a secondary stage, a painful inguinal lymphadenopathy is developed (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>) forming abscesses and presenting like buboes which may break down and drain spontaneously; this occurs in less than a third of patients. The latter may show the so-called groove sign, which consists of the appearance of a groove between the inguinal and femoral lymph nodes caused by Poupart's ligament. Finally, if no treatment is administered, a tertiary or fibrotic stage takes place, resulting in irreversible lymphedema or elephantiasis of the external genitalia<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a>. The diagnostic method of choice is DNA detection by PCR in a two-step procedure: a first generic test for C. trachomatis and, if this is positive, LGV genovar‐specific C. trachomatis DNA (L1-L3) should be detected from the same specimen. In the absence of the latter, serological assays are a valid alternative, as high titers of IgA anti-MOMP antibodies are indicative of LGV<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2,3</span></a>. Samples from genital lesions include ulcer base exudate, buboes aspirate, urethral exudate or first-catch urine specimen. A biopsy of the lesion may be useful when microbiology is inconclusive. In addition, screening for other sexually transmitted infections such as HIV, hepatitis B and C, and syphilis should be advised during a follow‐up visit, 3 months after the LGV diagnosis. Treatment for LGV should be provided to both the patient and his or her sexual contacts for the last 3 months. Along with sexual abstinence, the therapeutic regimen of choice is doxycycline 100 mg every 12 h for 3 consecutive weeks, whether the patients are symptomatic or not, in both healthy and HIV-positive populations. If this regimen is used, a test of cure is not required. There are alternative treatment options, such as erythromycin 400 mg every 6 h for 21 days, or regimens with azithromycin, moxifloxacin and minocycline, which have less evidence and always require a test of cure. Drainage or reconstructive surgery techniques in case of fibrosis and stenosis can also be performed as adjunctive measures<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a>.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Melgosa Ramos FJ, Sánchez-Martínez EM. Linfogranuloma venéreo. Manejo actualizado a propósito de un caso. Actas Urol Esp. 2021;45:245–246.</p>" ] ] "multimedia" => array:1 [ 0 => array:8 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 366 "Ancho" => 1250 "Tamanyo" => 57698 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">(A) Painless, indurated, ulcerative penile lesion. (B) Soft and painful right inguinal bubo.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:3 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Concern regarding the alleged spread of hypervirulent lymphogranuloma venereum <span class="elsevierStyleItalic">Chlamydia trachomatis</span> strain in Europe" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "H.M. Seth-Smith" 1 => "J.C. Galan" 2 => "D. Goldenberger" 3 => "D.A. Lewis" 4 => "O. Peuchant" 5 => "C. Bébéar" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.2807/1560-7917.ES.2017.22.15.30511" "Revista" => array:3 [ "tituloSerie" => "Euro Surveill" "fecha" => "2017" "volumen" => "22" ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "2019 European Guideline on the management of lymphogranuloma venereum" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:7 [ 0 => "H.J.C. De Vries" 1 => "B. De Barbeyrac" 2 => "N.H.N. De Vrieze" 3 => "J.D. Viset" 4 => "J.A. White" 5 => "M. Vall-Mayans" 6 => "M. Unemo" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/jdv.15729" "Revista" => array:6 [ "tituloSerie" => "J Eur Acad Dermatol Venereol" "fecha" => "2019" "volumen" => "33" "paginaInicial" => "1821" "paginaFinal" => "1828" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/31243838" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0015" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Lymphogranuloma venereum 2015: clinical presentation, diagnosis, and treatment" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "B.P. Stoner" 1 => "S.E. Cohen" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1093/cid/civ756" "Revista" => array:5 [ "tituloSerie" => "Clin Infect Dis" "fecha" => "2015" "volumen" => "61 Suppl 8" "paginaInicial" => "865" "paginaFinal" => "873" ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/21735786/0000004500000003/v1_202104020851/S2173578621000238/v1_202104020851/en/main.assets" "Apartado" => array:4 [ "identificador" => "6296" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Letter to the editor" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/21735786/0000004500000003/v1_202104020851/S2173578621000238/v1_202104020851/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173578621000238?idApp=UINPBA00004N" ]
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