A female aged 25 years having lesions on tongue , perineal and vaginal region since 4 months. VDRL and HIV test is negative. lady is non diabetic. Her husband is driver in metropolitan city.

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Ask for history of weight loss. Ask for history of TB and family history of TB. Do CD 4 count, PPD, Chest X ray, TPHA test. Take swab from wound for Gram staining and c/s. Examine cervix and vagina for any lesions and take a PAP smear and also swab from vagina for c/s. Do abdominopelvic usg to see for any intra abdominal or pelvic pathology. Do HIV and VDRL test of husband. Review with above for treatment and further management.
May be case of Aids . The tongue looks like syphilitic geographic and venereal infections at the rt and left labial side of vaginal entrance . It is a typical case of HI V with super infection may be fungal or cancerous especially squamous cell carcinoma because of depletion of immunity . Vaginal discharges . Better Elisha test should be done and pt has to go for anti HIV drugs for some relief and counseling should be done
VDRL test and HIV test is negative.
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A case of Steven johnson syndrome As it includes lesion on vagina-vaginitis, balanitis, urethritis and also on oral mucosa. So it can be erythema multiforme D/d- Lesions of skin- Lichen planus Pemphigus Erythema multiforme Psoriasis
Further go for investigations and do comment on lymph nodes and h/o patient?
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But long time truck drivers r more prone to getting sexually transmitted diseases may be venereal diseases and lack of drug therapy she may get lymphadenopathy and super infections like fungal and other leprosy (leprobacilli ).may be very common in these truck drivers . Hygiene of the sexual parts not maintained .
What about the buccal mucosa and palatal mucosa????biopsy of the lision is advised...D/D Includes lichen planus too along with HIV
We also have to include PEMPHIGUS VULGARIS IN DIFFERENTIAL
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If husband is negative for Hiv n vdrl, then treat with anti fungal n antibiotics n good hygiene
Can be behcets syndrome..check for pathergy reaction...also check for any opthalmo problem..
Candidiasis. To Do:Blood culture and biopsy and examine her husband also.
Culture results can be fruitful too..but definitely aggressive stage
Take Biopsy of the lesion . Syphilis. Candidial infection.
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