Paraneoplastic pemphigus (PNP) is a rare, severe autoimmune mucocutaneous disorder most commonly associated with lymphoproliferative malignancies. Here, we report the first documented case of PNP as a paraneoplastic manifestation of multiple myeloma (MM). A 61-year-old male with MM developed widespread mucocutaneous ulcerations shortly after his eleventh chemotherapy cycle, initially suspected to represent Stevens-Johnson syndrome. Clinical examination revealed diffuse skin peeling, mucosal involvement of the eyes, oral cavity, and genital region, and a positive Nikolsky sign. Laboratory evaluation demonstrated acute kidney injury requiring hemodialysis. Despite initial treatment with high-dose intravenous immunoglobulin, lesions persisted. Skin biopsy revealed lichenoid lymphocytic infiltration, basal vacuolar changes, subcorneal and suprabasal acantholysis, and keratinocyte dyskeratosis, confirming PNP. Viral serologies were negative, supporting the autoimmune etiology. The patient was subsequently treated with rituximab, resulting in significant improvement of cutaneous lesions over three months, with residual post-inflammatory hyperpigmentation. This case emphasizes the importance of early recognition and accurate differentiation of PNP from other blistering disorders in patients with underlying hematologic malignancies. Importantly, this represents the first reported instance of PNP presenting as a paraneoplastic manifestation of MM, highlighting the need for awareness of atypical autoimmune syndromes in this population.

BackgroundGenital mpox has been scarcely described in Central and West Africa where the disease is endemic. This study aimed to describe the clinical manifestations of genital mpox acquired through sexual contact in heterosexual African couples.MethodsThis was a case series of patients presenting with genital lesions associated or without febrile pustular or vesicular eruptions and confirmed with a positive PCR. Medical records of patients were scrutinized between March 2022 and December 2025 in three dermatology centres located either in Cameroon or Benin. Sociodemographic characteristics, clinical features, laboratory results, treatment, and outcomes were systematically documented.ResultsIn total, nine cases of genital mpox from six heterosexual couples were documented. Patients' median age was 35 years (IQR 31-42 years; range: 28-45 years). Two heterosexual partners were living with HIV with undetectable plasma viral loads. Sexual contact preceding genital lesions' onset was reported in seven of 9 cases (78%). The incubation period ranged from 3 to 10 days. Clinical manifestations included vesicles, pustules, erosions, ulcerations, genital edema, umbilicated necrotic papules, and inguinal lymphadenopathy. The morphology of lesions varied from rounded/oval to arcuate and linear patterns. The recovery time ranged from 2 to 8 weeks, though longer for ulcerations. People living with HIV experienced severe presentations and prolonged recovery.ConclusionGenital manifestations of mpox on black skin are polymorphic and can present with atypical features. Mpox should be considered as a differential diagnosis of genital lesions following condomless sexual intercourse, particularly in endemic areas.

Behçet's disease is a complex, multisystem inflammatory vasculitis of unknown etiology, characterized by a highly heterogeneous clinical presentation that may delay recognition, particularly in the emergency setting. We report a case of a 15-year-old girl presenting to the emergency department with a first episode of painful genital ulceration associated with erythema nodosum and persistent fever. Laboratory investigations revealed a marked inflammatory syndrome without an identifiable infectious cause. Based on clinical findings and according to the International Criteria for Behçet's Disease (ICBD), a score of 5 was obtained, supporting the diagnosis. This case underscores the diagnostic challenges associated with early-stage Behçet's disease, especially in young patients presenting with incomplete or atypical clinical features. It highlights the importance of maintaining a high index of suspicion in the emergency setting to facilitate timely diagnosis and appropriate management.

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.