“GENITALIA ULCER”FIKRIATUL FADHILLAH 110 209 0083ANDI FIRMAN MUBARAK 110 209 0088DZUL IKRAM 110 209 0108

MINI POSTER

PATIENT’S IDENTITY

• Name : Mr. S• Gender : Male• Age : 58 y.o• Marital Status : Married• Religion : Moslem• Address : Limbung, Gowa• Occupation : Farmer• Registered : 16 February 2013

HISTORY TAKINGAnamnesis : (Heteroanamnesis)Chief complaint : pain on the genital areaFurther Anamnesis :Since 3 years ago (2011), Intermitten. On the last 3 months, become more severe. And 20 days ago, wound appeared on the penis, the patient felt pain on his wound. and now the wound is bleeding. The patient also had swelling at the penis and scrotum. Next 5 days reddish bumps like a corn seed to murbles appears at the right and left thigh, lower stomach and scrotum.History of urinating: bloody urine with pus since 2 years ago and there is pain after urinating. Patient felt pain when he had sexual intercourse. Hip pain on the left side since last year, the pain is intermitten and getting severe in the night. And it’s getting worst in the last week

• Appearance of the bumps as big as marble in large amount on the inner of right thigh since 20 days ago, started by swelling of the penis and scrotum. 5 days after the swelling, there were a lot of new bumps around the genital & thigh area.

Systematical Anamnesis :• Fever (-), decrease of appetite, dyspnea when

doing activity and release by rest. • Cough (-), chest pain (-), nausea (+), vomit (-)• Defecation : since registered, the patient has not

been defecating.

• Sexual intercourse to others disclaim• Patient had the same complaint : ( - )• Family History with the same complaint : ( - )• Treatment history : had been treated by

Puskesmas in 2011 for hip pain

• Lifestyle : smoking (-)alcohol (+)exercise (+),

• Allergic : ( - )• Systemic disease : Hypertension

PRESENT STATUS

• General condition : Severe• Consciousness : Compos mentis • Vital sign : BP: 150/80 mmHg

Pulse: 96x/minute, reguler

Breathing: 28x/minute

Temperature: 36,8 0 C

• Head Examination : icteric (-)Anemic (-)cyanosis (-)

• Cor / Pulmo : Normal/Normal• Thorax : Symetrical Rh (-)/Wh(- )• Abdomen : Normal, Peristaltic (+)• Extremities : Symmetric pretibial

oedema, pitting (+)• Lhymp Nodus : lhympadenopati (+)

at inguinal sinistra and dextra

• Localization : Genital area and inferior extremities.

• Dermatology Status- Location : Regio Femoralis Dextra et Sinistra

Efflorescence : Papul, Nodul- Location : Regio Suprapubic

Efflorescence : Papul, Nodul

• Venerology Status- Location : Regio Penis

Efflorescence : Ulcus, Nodul, Tumor, OUE Erithema - Location : Regio Scrotum

Efflorescence : Papul, Nodul

• Additional Examination- Laboratory : VDRL (-), PLT 435!H 103/mm3, RBC 3,81 106/mm3 , WBC 16,3 !H 103/mm3 ,, GDS 111, Ureum 48 Creatinin 14, GOT 47, GPT 14, Xray Normal thorax, elongation aorta, (In order : Sensitivity and Culture)

RESUME• Patient 58 y.o registered on 16 february 2013 with chief complaint is pain on the genital area

Since 3 years ago (2011), Intermitten. On the last 3 months, become more severe. And 20 days ago, ulcus appeared on the penis, the patient felt pain on his ulcus. and now the ulcus is hemorrage. The patient also had oedema at the penis and scrotum. Next 5 days tumors like a corn seed to murbles appears at the dextra and sinistra femoralis, suprapubic and scrotum. hematuria (+), pyuria (+), Dyspareneu (+), pretibial udem (+), swelling of scrotum and penis (+), lhympadenopati (+) at inguinal sinistra and dextra nausea (+), sexual intercourse to others disclaim.

• Vital sign: BP: 150/80 mmHg, Pulse: 96x/minute, reguler, Breathing: 28x/minute, Temperature: 36,8 0 C

• Dermato-venerology :- Location : Regio Femoralis Dextra et Sinistra

Efflorescence : Papul, Nodul- Location : Regio Suprapubic

Efflorescence : Papul, Nodul- Location : Regio Penis

Efflorescence : Ulcus, Nodul, Tumor, OUE Erithema- Location : Regio Scrotum

Efflorescnece : Papul, Nodul

DIAGNOSIS- Genitalia Ulcer

MANAGEMENT- Topical : Fuson Cream 30gr + Ictiol 10gr Twice

a day (Morning, afternoon) NaCl 0,9% Compress twice a day

- Systemic : IVFD RL 20 TPM gentamicin: 80 mg/12 hours/IV ketorolac: 1 amp/8 hours/IVVit C : 3g/12 hours/IVNonflamin 3x1

PROGNOSIS- Dubia

GENITALIA ULCER• Genital Ulcers are rare as an initial manifestation. They are

usually a secondary or tertiary manifestation however, genital ulcer tend to appear as the disease a progresses.

• In males, the scrotum is the most common site, but affected areas may included the prepuce glands penis and the shaft of the penis, walking can cause severe pain due to the resulting friction.

• Characteristic punched out, well defined ulcer; variable number and size; dried crust or grayish-white exudate covering the base of the ulcer; gray necrotic lession formation with accompanying pain;

• Progress reccurrence less common than oral ulcer;• Deep and large ulcer often cause scarring.

ETIOLOGIES

• Syphilis• Herpes• Chancroid• Lymphogranuloma venereum• Donovanosis

Sites of Genital ulcer in 155 male patients

SITE NUMBER OF PATIENT

PERCENTAGE

SCROTUM 107 69,0

PENIS 103 66,5

GROIN 23 14,8

DIFFERENTIAL DIAGNOSIS

• Penis Carcinoma • Squamous Cell Carcinoma

• Lession : Ulcus at the penis

• Lession : ulcus at the penis

TREATMENT• counseling• Symtomatic therapy• Depend on causality

PROGNOSIS• Depend on early diagnostic but severe to the people

who have immunodeficiency.• Proper medication• counseling