Man with bilateral inguinal lymphadenopathy

Clinical introduction

A 37-year-old man with history of lymph node tuberculosis presented with bilateral inguinal swelling with night sweats but no fever for 2 weeks. He had a cat but he had no history of scratches. He had an extraconjugal sexual intercourse a few weeks before. Physical examination revealed 5 cm tender, erythematous and painful bilateral inguinal adenopathy (figure 1A) and a small ulceration at the base of the penis (figure 1B). Vital signs were normal.

Question

What is the most likely diagnosis?

Toxoplasmosis

Tuberculosis

Cat-scratch disease

Lymphogranuloma venereum

Syphilis

Answer

C. Cat-scratch disease

Toxoplasmosis, syphilis and tuberculosis-associated lymph node are generally painless, so these diagnoses were unlikely. Cat-scratch disease usually presents with unilateral lymphadenopathy. Thus the most likely diagnosis was lymphogranuloma venereum, a sexually transmitted disease caused by Chlamydia trachomatis serovar L, which must be considered in a sexually active...

https://ift.tt/2mvauck