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Case of the Month - June 2018

Case courtesy of: Bernadett I. Gosnell, Sonal R. Verma, Virgilio J. Da Conceicao, Nithendra Manickchund, M. Yunus, S. Moosa, Department of Infectious Diseases, Nelson R. Mandela School of Medicine, and King Edward VIII Hospital, Durban

A 46-year-old female patient was seen at KEH VIII hospital.

Presenting complaints: Non-healing ulcers of 4 months duration in the genital region, left infra-mammary region, right lateral tongue and lower lips. She also complained of weight loss, malaise and anorexia. She had no fever, no night sweats, no dysphagia, no odynophagia and no other gastrointestinal symptoms.

Past medical history: She was HIV-seropositive on first-line antiretroviral therapy (TDF/FTC/EFV) for the last seven years. Her most recent CD4 count was 3 cells/┬ÁL, viral load 29 056 RNA copies/ mL (4.46 log), suggesting that she had been failing treatment for a while. She was diagnosed with pulmonary tuberculosis four years ago and completed six months of appropriate treatment. She was known to be allergic to trimethoprim/ sulfamethoxazole

Social history: She did not smoke or drink alcohol. She was employed but had been on sick leave for the last two months.

Figure 1: Genital lesions

Figures 2-4: Ulcerative lesions on lip and inframammary region

Question 1: What are the commonest causes of genital ulcer disease in South Africa?

Continue to Answer 1