Genital Crohn's disease (GCD) is an infrequent extraintestinal manifestation of Crohn's disease characterized by ulceration, pain, edema, and erythema in the anogenital area. GCD poses significant diagnostic and management challenges, mainly because there are no standardized clinical protocols. This review analyzed 20 case reports and series from 1983 to 2024, focusing on patients with GCD. The databases used for this search were PubMed, Scopus, and Google Scholar. The most common presentation in male patients was genital edema or swelling, seen in 88.9% of cases. Pain was the main presentation in 71.9% of cases among female patients. Several complications were reported, including rectovaginal and enterovaginal fistulas, tubo-ovarian abscesses, and penile involvement. The diagnosis was made based on clinical evaluation, which was supported by laboratory tests, physical examinations, imaging, and endoscopic procedures. Histological examinations of biopsied genital ulcers demonstrated non-caseating granulomatous inflammation; however, this finding was observed in only 50% of patients. Moreover, pelvic magnetic resonance imaging is highlighted as a crucial diagnostic tool. The most common form of treatment is pharmacological therapy. Corticosteroids, immunosuppressants, and tumor necrosis factor-alpha inhibitors are the most frequently used drugs. A total of 14 studies reported that corticosteroids administered via intravenous and oral routes resulted in a notable reduction in disease severity. The tumor necrosis factor-alpha inhibitors adalimumab and infliximab showed notable efficacy. New therapies such as carbon laser therapy and autologous stem cell transplantation showed promising outcomes in refractory cases. Surgical procedures are reserved for refractory or complicated cases. This review highlights that medical management with corticosteroids, immunomodulators, and biologics remains the cornerstone of treatment for GCD, with surgery playing a role in refractory disease.

Pyodermatitis vegetans (PDV) is a rare, chronic inflammatory dermatosis associated with inflammatory bowel disease (IBD), particularly ulcerative colitis. Though PDV has been documented globally, it remains rare in pediatric populations and under-reported in Pakistan. This case highlights an adolescent male with suspected IBD presenting with extensive cutaneous manifestations consistent with PDV. A 17-year-old male presented with a 10-year history of recurrent vegetative skin lesions, which initially started behind the left ear and then involved the face, axillae, back, chest, buttocks, gluteal cleft, and genitals. He also reported red, itchy, ring-like lesions on the limbs with systemic complaints, including nausea, anorexia, constipation, painful defecation, and fresh rectal bleeding. Physical examination revealed multiple verrucous plaques, nodular eruptions, crusted lesions, and acne scars. Blood workup showed microcytic hypochromic anemia and elevated serum IgE (1375 IU/mL). Histopathological examination of the skin biopsy shows features diagnostic of PDV, including hyperkeratosis, parakeratosis, follicular plugging, elongation of rete ridges, and dermal fibrosis with lymphocytic infiltration. Considering the clinical features and laboratory findings, the final diagnosis made is pyodermatitis vegetans. This study emphasizes how crucial it is to treat PDV as an uncommon extraintestinal sign of IBD in teenagers who exhibit persistent vegetative skin lesions. Accurate diagnosis, mimicking exclusion, and prompt therapy intervention to address underlying systemic connections all depend on multidisciplinary collaboration and teamwork.

Herpes simplex virus 2 (HSV-2) is associated with genital ulcers, neonatal encephalitis, increased risk of HIV infection, and dementia. There is no licensed HSV-2 vaccine. We developed nanoparticles displaying the HSV-2 attachment protein gD and fusion mediation protein complex gH/gL. Immunization of mice and non-human primates elicited high levels of neutralizing antibodies. Vaccination conferred robust protection in mice, preventing disease and nearly eliminating infection and shedding following HSV-2 challenge. While gD induced high neutralizing antibody titers, gH/gL contributed substantially to protection despite lower neutralization titers. Instead, gH/gL immunization generated strong fusion-blocking responses which were an important correlate of protection, showing that standard neutralization assays incompletely capture the importance of fusion-blocking activity. These findings demonstrate that targeting both HSV-2 attachment and fusion elicit complementary mechanisms for protection from infection and that neutralizing antibody alone may be insufficient for protection. Overall, these results present an innovative strategy for an HSV-2 vaccine.

We report on a 21-year-old man of Syrian descent who presented with a severe flare of ulcerative colitis (UC) initially diagnosed two years earlier. Colonoscopy revealed pancolitis sparing the descending colon and sigmoid colon, prompting a revised diagnosis of Crohn's disease (CD). Shortly thereafter, the patient developed oral, genital and inguinal ulcers along with papulopustular lesions on the trunk. This led to a further revision of the diagnosis to Behçet's syndrome (BS). Treatment with a short course of prednisolone followed by infliximab therapy induced remission. This case highlights the diagnostic challenges in distinguishing BS from inflammatory bowel diseases such as UC and CD.

A 48-year-old transgender woman presented with a sudden onset of bloody stool. Colonoscopy revealed an ulcerated, circumscribed mass in the lower rectum, closely resembling a Borrmann type 2 malignancy. The patient lacked classic signs of syphilis, such as anal pain, primary genital chancres, or localized lymphadenopathy. However, serological assays were highly reactive, and immunohistochemical analysis of the biopsy specimen confirmed the presence of Treponema pallidum, establishing the diagnosis of syphilitic proctitis. A four-week oral amoxicillin regimen (1,500 mg/day) led to complete clinical and serological resolution. This elusive condition must be considered when evaluating anorectal mucosal abnormalities.