case_images: PMC5360951_01
case_images: Appearance of tumorous lesions on the scrotum and perineum on admission.
case_images: CRIID2017-1589356.001.jpg
case_images: PMC5360951_01_CRIID2017-1589356.001.jpg
case_images: fig1
case_images: Physical exam was unremarkable except for three exophytic, nontender nodular lesions, about 1-2 cm in diameter, along the left side of the scrotum and a 5 cm in diameter mass in perineal region (Figure 1).
case_images: Histological sections of the lesion showing acute inflammatory and lymphoplasmacytic infiltrate in the dermis (hematoxylin-eosin (HE)), original magnification x40).
case_images: CRIID2017-1589356.002.jpg
case_images: PMC5360951_01_CRIID2017-1589356.002.jpg
case_images: fig2
case_images: The biopsy specimen revealed an ulcerated epidermis with an associated acute inflammation and prominent lymphoplasmacytic infiltrate (Figure 2).
case_images: (a) Histopathologic appearance showing epithelial cell with viral inclusions. (b) Histopathologic appearance showing multinucleated cells (HE, original magnification x400).
case_images: CRIID2017-1589356.003.jpg
case_images: PMC5360951_01_CRIID2017-1589356.003.jpg
case_images: fig3
case_images: Along the base of the ulceration were epidermal cells demonstrating viral cytopathic changes and multinucleated giant cells (Figures 3(a) and 3(b)).
case_images: Cells from the biopsy specimen showing positive immunostaining for HSV-2 (a) and HSV-1 (b) (original magnification x400).
case_images: CRIID2017-1589356.004.jpg
case_images: PMC5360951_01_CRIID2017-1589356.004.jpg
case_images: fig4
case_images: These cells stained positively with HSV-1 and HSV-2 immunostains (Figures 4(a) and 4(b)).
case_images: Appearance of pseudotumoral lesions on scrotum (a) and perineum (b) 11 days after starting leflunomide.
case_images: CRIID2017-1589356.005.jpg
case_images: PMC5360951_01_CRIID2017-1589356.005.jpg
case_images: fig5
case_images: The patient received 23 days of foscarnet, 14 days of topical imiquimod, and 11 days of leflunomide with approximately 80% reduction in the size of the perineal lesion compared to the size at the time of hospital admission (Figure 5).