A rare and atypical cause of scrotal ulcerations

Abstract

Salmonelloses are bacterial infections of the faecal peril; they are endemic in some regions of the world. They can colonize almost any organ hematogenously, hence, severe forms may be observed. We report a case of typhoid fever in a 16-year old young adolescent with no medical history, sexually transmitted diseases or sexual intercourses, presenting with necrotic scrotal ulcerations evolving over the past 3 weeks in a context of fever, diarrhoea, weight loss and alteration of the general state. Paraclinical assessment showed 7g/dl hypochromic microcyticanemia with target cells in blood smear and normal hemoglobin electrophoresis, biologic inflammatory syndrome, malabsorption syndrome, cytolysis and hepatic cholestasis 20 times above the normal, hepatosplenomegaly, normal viral serologic testing (HBV, HCV, HIV, EBV and CMV) and positive testing for salmonella. The patient underwent 3 weeks of therapy with fluoroquinolones with favorable evolution. Dermatologic manifestations are frequent and polymorphic in typhoid fever; however cutaneous and, in particular, scrotal ulcerations are rarely reported. Differential diagnosis may be based on sexually transmitted diseases, inflammatory bowel diseases or hematologic disorders. More often diarrhoea is reduced or absent and patient’s outcome depends on antibiotic. Diagnostic confirmation in patients with an atypical clinical picture, as in the case of our patient, is based on serology. Treatment is based on proper and prolonged antibiotic therapy and on prophylaxis measures to neighbouring.