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STUDENT CASE SSS WEEK 2 (Case Kelamin Student)

1. Rian presented with a penile ulcer and rash all over his body. Laboratory tests found spirochetes in his ulcer discharge and fungal spores in his skin scraping. 2. He was diagnosed with primary syphilis based on positive serology tests and darkfield microscopy findings. The rash was likely tinea versicolor based on KOH microscopy. 3. He was treated for primary syphilis with benzathine penicillin injections but did not complete treatment. His untreated syphilis infection could cause complications for his pregnant wife and baby.

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73 views7 pages

STUDENT CASE SSS WEEK 2 (Case Kelamin Student)

1. Rian presented with a penile ulcer and rash all over his body. Laboratory tests found spirochetes in his ulcer discharge and fungal spores in his skin scraping. 2. He was diagnosed with primary syphilis based on positive serology tests and darkfield microscopy findings. The rash was likely tinea versicolor based on KOH microscopy. 3. He was treated for primary syphilis with benzathine penicillin injections but did not complete treatment. His untreated syphilis infection could cause complications for his pregnant wife and baby.

Uploaded by

girv
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Block: Skin & Special Senses

Week Title: Sexually Transmitted Disease, Emergency Skin Condition

WEEK OBJECTIVES:
1. to gain an overview of structure and function of the genital tract
2. to explain classification of sexually transmitted disease
3. to understand pathogenesis, causative agents, transmission and prevention of
sexually transmitted disease
4. to explain the principles in the treatment of sexually transmitted disease
5. to describe some of the laboratory test used in the diagnosis of venereal disease
6. to understand how venereal disease affects the patient’s quality of life and
psychosocial issues
7. to recognize the approach of the health care team work together to treat the whole
patient
8. classify and describe the pathology and pathogenesis on skin cancer
9. describe the management of skin malignancy, its referral system and prognosis of
the diseases
10. to know the diagnosis and management of emergency skin disorders and its
referral system and prognosis of the disease

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Tutorial 1
Page 1

Rian, a 40-year-old man came to a hospital because his penis had a painless solitary ulcer
since 1 month ago. He also had rash on all of his body since 2 days ago, but he didn’t
complain of itch nor pain.

He had no significant prior medical condition or sexually transmitted disease history.


Rian denied intravenous drug use. He had no allergies to drug nor food. He had mild
discharge, dysuria. He had o history of rash of pruritus on his external genitalia. He had
consumed many medicine (forgot the brands), but they were not helpful.

He had been sexually active for 2 years with many prostitute women. He didn’t know if
his partners were bisexsual or drug users.

What are the problems of Rian?

What might be the possible causes and how do you explain your hypothesis?

What further information you need to establish your hypothesis?

2
Tutorial 1
Page 2

On physical examination, doctor found:


He was afebrile, BP 120/80 mmHg, pulse 69x/minute, RR 20x/minute, with normal
mental status. Examination of the oropharynx showed normal mucosa, but the doctor
swab specimens for microscopic and culture examination.

His penis has a solitary ulcer 0.5 x 0.2 x 0.1 cm, base is clean with scant yellow serous
discharge. The border of ulcer is raised, smooth, and sharply defined. The lesion began as
a papule that underwent eroding, painless hard, indurated ulcer. There was inguinal
lymphadenopathy.
He had rash all over his body formed papule and eritema. Skin scrapping from the rash
were also taken to laboratory.

What is your differential diagnosis for this patient?

What is most likely the causative agent?

What further information should be acquired?

3
Tutorial 2
Page 3

Laboratory evaluation for ulcer was remarkable for the following:


1. Midstream urine specimen: a mixed growth of less than 103 CFU/ml bacteria
2. serology test showed: TPHA 1/160, VDRL 1/320
3. IgG and IgM HSV showed: negative
4. Complement fixation titer test showed: negative
5. Wet preparation from ulcer discharge demonstrated:
a. Giemsa-staining biopsy: no bipolar staining bacilli in vacuoles in
cytoplasm
b. Gram stain showed no multinucleated giant cell, no school-of-fish pattern
c. Dark field examination from discharge showed spiral bacilli
Laboratory test for rash:
Skin scrapping with KOH: spore (+), hypha (-), budding (-)

What is your interpretation of the microbiology results?

How is the illness transmitted?

What is the stage of Rian’s condition?

What management options do you have for him?

4
Tutorial 2
Page 4

The doctor treated Rian with Benzathin penicillin G 2.4 million U IM once a week. The
doctor suggested him to return to hospital once a week. The second week, Rian returned
for his second injection of Benzathin penicillin G 2.4 million U. The doctor suggested
him to return next week.

What is laboratory test for evaluation the treatment?

What complication s may follow this infection?

5
Tutorial 3
Page 5

He didn’t return to hospital for the third week treatment. He recovered uneventfully with
the medicine. One month later, he returned because his wife is now 3 months pregnant.
He was so sorry about his baby.

What complications may happen to the baby?

What laboratory test should be done to his wife?

Describe the pathogenesis of complication in his baby!

6
Tutorial 3
Page 6

His wife and Rian visited the doctor until their baby was born. Their baby was normal.
The doctor suggested them to come regularly and observe the baby’s condition.

What makes the doctor worried?

What should be observed in their baby?

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