Back issues No.1 - 2005 / Resident Forum  

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Nonhealing Perianal Ulcers
Jen-Chin Wu , Tien-Yi Tzung
Dermatol Sinica 23:56-57,2005

A 67-year-old heterosexual Chinese male presented with a one-year history of
persistent multiple painful well-defined punched-out ulcers around the anus and in the
perineum without involvement of anal mucosa (Fig. 1). There was no
lymphoadenopathy on the groin. He had been treated as herpes simplex viral infection
with topical and oral antiviral agents without improvement. In addition, he was known
to have central diabetes insipidus for 14 years and received nasal desmopressin
management. Cultures were obtained for viruses, fungi, and acid-fast bacilli, and all
were negative. The results of complete blood cell count, differential count, chest and
whole body bone X-ray, abdominal sonography, enhanced computed tomography of
the brain with thin slice sections of the sella tursica were unremarkable.
A biopsy specimen was obtained for histopathologic and electron microscopic
analysis (Fig. 2 and 3).

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