trimethoprim--sulfamethoxazole-drug-combination and Vulvar-Diseases

BACKGROUND Stevens Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are causes of rare but life-threatening emergencies characterized by desquamation of the skin and mucosa. As SJS most commonly presents with skin rash followed by mucosal involvement, we present a case of vulvovaginal lesions as the initial presentation with progression to SJS after re-exposure to the culprit drug. CASE REPORT A 27-year-old female with acute cystitis was given trimethoprim-sulfamethoxazole. After 2 days, she reported vaginal pain. Three days later, she was hospitalized with vulvovaginal ulcerations and restarted on trimethoprim-sulfamethoxazole, leading to worsening vaginal lesions with rapid desquamation of conjunctival and oropharyngeal involvement. Biopsies of arm lesions revealed SJS. CONCLUSIONS It is important to recognize SJS as a rare but life-threatening cause of vulvovaginal ulceration, as early diagnosis is vital for successful treatment.

Topics: Adult; Anti-Infective Agents, Urinary; Female; Humans; Pain; Skin Ulcer; Stevens-Johnson Syndrome; Trimethoprim, Sulfamethoxazole Drug Combination; Vulvar Diseases

To estimate the incidence of methicillin-resistant Staphylococcus aureus (MRSA) among women with vulvar abscesses and to describe clinical factors associated with inpatient compared with outpatient treatment.. We reviewed all women with a vulvar abscess who were treated with incision and drainage between October 2006 to March 2008. We reviewed the abscess cultures and evaluated clinical and laboratory variables associated with inpatient compared with outpatient treatment.. During the 80-week study period, 162 women were treated for a vulvar abscess. Methicillin-resistant S aureus was isolated from 85 of 133 (64%) cultured vulvar abscesses. No presenting signs or symptoms were more common among patients with MRSA abscesses. Women with an MRSA vulvar abscess were not more likely to require inpatient admission or experience treatment complications. Inpatient treatment occurred in 64 of 162 (40%) patients and was predicted by medical comorbidities: diabetes (45.3%, odds ratio [OR] 2.29, 95% confidence interval [CI] 1.12-4.72), hypertension (34.4%, OR 2.33, 95% CI 1.06-5.13), initial serum glucose greater than 200 (37.5%, OR 3.32, 95% CI 1.48-7.51), and signs of worse infection, ie, larger abscesses (mean 5.2 cm) (P<.001) and elevated white blood cell count of at least 12,000/mm3 (45.3%, OR 3.04, 95% CI 1.44-6.43).. Methicillin-resistant S aureus was the most common organism isolated from vulvar abscesses. Inpatient treatment is more common in women with medical comorbidities, larger abscesses, and signs of systemic illness. An antibiotic regimen with activity against MRSA, such as trimethoprim-sulfamethoxazole, should be considered in similar populations with vulvar abscesses.

Topics: Abscess; Adult; Anti-Infective Agents; Female; Humans; Methicillin Resistance; Staphylococcal Infections; Staphylococcus aureus; Texas; Trimethoprim, Sulfamethoxazole Drug Combination; Vulvar Diseases

Topics: Adult; Anti-Infective Agents, Urinary; Drug Therapy, Combination; Female; Humans; Metronidazole; Trimethoprim, Sulfamethoxazole Drug Combination; Ulcer; Vulva; Vulvar Diseases

A case of granuloma inguinale of the oral cavity clinically resembling actinomycosis is reported. This condition should be considered in the differential diagnosis of chronic ulcerative lesions of the mouth, especially in patients with associated genital ulcers.

Topics: Actinomycosis; Adult; Diagnosis, Differential; Drug Combinations; Female; Granuloma Inguinale; Humans; Mouth Diseases; Sulfamethoxazole; Tetracycline; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination; Vulvar Diseases