Case Study : Dermatology

179. Genital Bullous Impetigo 

193. Itchy rash in groin

A 42-year-old man presented with an itchy rash in the groin which had been present for 4 days.

Genital Bullous Impetigo

 

Staphylococcal genital infections are fairly common, and usually present as furunculosis or crusting impetigo. 

 

Bullous impetigo is seen occasionally, and may be difficult to distinguish from other vesiculating rashes, such as those caused by herpesviruses and vesiculating dermatoses.

Microscopy of vesicle fluid typycally shows:

  • +++ polymorphs

  • gram positive cocci in clusters

In this case, a gram stain of vesicle fluid  showed organism with typical staphylococcal morphology, thus allowing a (fairly) confident diagnosis to be made at presentation, with prompt introduction of specific antibiotic therapy

He was treated with flucloxacillin, together with valaciclovir pending result of Herpes simplex PCR.

At review a week later, the lesions had healed. 

HSV PCR was negative and culture of vesicle fluid resulted in a heavy growth of Staphylococcus aureus.

REFERENCES

Genital Bullous Impetigo

Melbourne Sexual Health Centre

December 2008

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