A 30-year-old man with recent diagnosis of HIV-infection was seen in the hospital, because of a 1-month history of swollen lips, painful oral mucosa ulcers, cervical lymph nodes and skin lesions. The medical history showed a previous patient contact with 10 subjects, with positivity for Monkeypox virus in 8 subjects. A week later, he began with lesions on the genitals, managed with acyclovir, and subsequent development of manifestations in the mouth and skin, with dissemination to the entire body. He was admitted to our clinic for increased volume in penis and scrotum, and a disseminated dermatosis affecting all body segments, characterized by polymorphic lesions reflecting various stages; the condition presents as infiltrated plaques with a central eschar and two halos at the periphery: one pale and another erythematous, of varying sizes, accompanied by significant edema (Figure 1A). In the mouth there was lip edema, with the presence of multiple superficial round ulcers and vesicles, with a hemorrhagic center and a white-yellowish border, that coalesce forming circinate plaques, with serohematic crusts on the upper vermilion and hematic and meliceric crusts on the lower one, as well as pale mucosa (Figure 1B). Intraorally, painful large shallow ulcers, covered with fibrin and hemorrhagic areas, with rounded and irregular edges, affected both labial mucous membranes, the hard palate and gums, with gingival enlargement and necrosis of the interdental papillae (Figure 1C); the tongue showed partial atrophy of filiform papillae with some isolated punctiform ulcers. A presumptive diagnosis of Monkeypox infection was suggested. Biopsies on lower labial mucosa and plantar skin were performed. Analysis of blood test revealed: hemoglobin 10.8 (13.1 - 18.1) g/dL, iron 22 µg/dL (50 - 212), ferritin 2362 (23 - 336,2) ng/mL, leukocytes 10.8 (3.9 - 10.1)/mm3, aspartate aminotransferase 47.3 (13 - 39) U/L, albumin 2.4 (3.5 - 5.7) g/dL, CD4 count 121 (500-1500) cells/mm3 and HIV-viral load 312,000 (<20-75) copies/mL, starting antiretroviral therapy with bictegravir/emtricitabine/tenofovir alafenamide (biktarvy) and management with antibacterials and antivirals. The histopathological study of lesions was compatible with monkeypox infection and PCR test for the monkeypox virus confirmed the diagnosis (1,2). The patient had increased difficulty in swallowing, first with solids then with liquids; and, given the risk of airway obstruction due to oropharyngeal edema, a tracheostomy was performed. Disease progression was observed, with kidney damage and pulmonary dysfunction, and he died a month later. Mucocutaneous and other clinical features such as fever, chills, headache, muscular pains, backaches, and weariness, are some of the first symptoms of a Monkeypox infection.(2-5) A gradual maculopapular rash with lesion diameters ranging from 0.2-1 cm appears after the prodrome stage; initially on the face and neck, and moving to the legs with involvement of the palms and soles, spreading throughout the body.(2, 5) These last characteristics favored the initial diagnosis of a Monkeypox infection in our patient. Differential diagnosis should include other pox-like viruses, such as varicella, herpes zoster, measles, and arboviruses (Dengue, Zika and chikungunya). (2) This case represents a rare situation where the host rapidly developed progressive worsening of Monkeypox manifestations in HIV-infection.

Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) represent severe cutaneous adverse drug reactions characterized by extensive mucocutaneous necrosis and epidermal detachment. While these conditions are most commonly observed in association with sulfonamides and β-lactams antibiotics, emerging evidence indicates that fluoroquinolones may be linked to ~4% of cases. The current study presents a rare case of levofloxacin-induced SJS in a 55-year-old male with metastatic colon cancer. A total of 8 days after initiating levofloxacin, the patient developed a generalized erythematous rash, oral mucosal ulcerations and conjunctival hemorrhage. Despite discontinuation of the drug and the administration of dexamethasone, progressive epidermal detachment ensued, affecting 16% of the total body surface area, along with new perianal and scrotal erosions. Laboratory findings revealed persistent hypoalbuminemia, progressive azotemia and elevated procalcitonin. Despite active management, the patient ultimately succumbed to fatal septic shock and multiorgan dysfunction syndrome. This rare case highlights the need for heightened caution in administering fluoroquinolones to oncologically complex patients diagnosed with advanced colorectal cancer with malignant ascites and hypoalbuminemia prior to fluoroquinolone exposure. Furthermore, the findings suggest that malignant ascites and hypoalbuminemia may serve as novel prognostic indicators in patients with SJS/TEN and abdominal malignancies. These observations are valuable for refining current risk stratification models and provide a more precise basis for clinical decision-making in complex oncological patients to improve outcomes in this vulnerable population.

Kawasaki disease (KD) is an acute systemic vasculitis mainly affecting medium-size blood vessels and primarily affecting children under five years old. The typical clinical presentation associates fever, skin rash, mucous membrane abnormalities, and lymphadenopathies. Occurrence in adults is rare, with fewer than 100 cases reported and limited histological descriptions available, particularly regarding the skin. We report herein the case of a 22-year-old man hospitalized for fever, odynophagia, and aphagia since five days. Clinical examination revealed enanthem with palatal ulcerations, maculopapular lesions with fine scaling on the limbs and extremities, painful scrotal ulcerations, bilateral non-exudative conjunctivitis, and bilateral lymphadenopathy. Laboratory tests showed an isolated inflammatory syndrome. Skin biopsy revealed lichenoid epidermal changes along with a polymorphic dermal inflammatory infiltrate exhibiting a granulomatous pattern and comprising abundant lymphocytes, accompanied by vascular changes. The diagnosis of KD was established by integrating clinical and histological data. Early recognition of this disease in adults is essential to prevent chronic complications; this report aims to describe its potential histological features.

Immunoglobulin A (IgA) vasculitis, also known as Henoch-Schönlein purpura, is the most common systemic vasculitis in childhood. It primarily affects the skin, joints, gastrointestinal tract, and kidneys. Extrarenal genitourinary manifestations are uncommon, and penile involvement is exceptionally rare, with very few cases documented worldwide and, to our knowledge, none previously reported in Mexico. A previously healthy 10-year-old boy presented with a purpuric rash on the extremities, arthralgia, abdominal pain, and progressive penile edema. Physical examination revealed pharyngeal hyperemia, palpable purpuric lesions on the extremities, an edematous and tender penis, and scrotal papules. Laboratory studies were unremarkable, with no evidence of infectious or autoimmune processes. Testicular ultrasound excluded torsion or other surgical causes. A clinical diagnosis of IgA vasculitis with penile involvement was made, and treatment was initiated with intravenous methylprednisolone followed by oral prednisone, achieving complete resolution without sequelae. Genital involvement in Henoch-Schönlein purpura is rare and may mimic surgical urological conditions. Early recognition of this presentation helps avoid unnecessary interventions. Doppler ultrasound and clinical correlation are essential for diagnosis. In the absence of severity criteria, corticosteroid therapy combined with local supportive measures is usually effective. This case represents the first report in Mexico of Henoch-Schönlein purpura with penile involvement. It highlights the importance of considering this entity in the differential diagnosis of pediatric acute scrotum and demonstrates the effectiveness of conservative management.

A 61-year-old male presented with a history of fever and burning micturition for 1 week; 3 days after being started on nitrofurantoin 100 mg twice a day by a local practitioner, he developed rash over the body along with scrotal swelling and pain. Following admission to the local government hospital where he developed acute anterolateral myocardial infarction (MI), he was referred to our hospital. At admission, physical examination revealed reticular purpuric plaques with occasional ulceration over both lower limbs, upper limbs and abdomen with extensive scrotal purpura with necrosis. His pulse rate was 110/minute, oxygen saturation by pulse oximetry was 88% on ambient air and temperature was 101 °F. He was started on intravenous antibiotics and treatment for MI. Laboratory investigations revealed leucocytosis, thrombocytopenia, acute kidney injury and hepatic dysfunction. Scrotal ultrasound revealed epididymo-orchitis. The next day, the patient developed altered sensorium. Computed tomography of the brain showed an infarct in the right fronto-parietal region. Possibility of leukocytoclastic vasculitis (LCV) with systemic involvement as an adverse drug reaction to nitrofurantoin was considered; vasculitis-related blood work-up was inconclusive. Punch biopsy of the lesion showed LCV with subepidermal bulla formation. Patient was treated with intravenous corticosteroids (dexamethasone 8 mg thrice-daily), antibiotics and symptomatic management. He was discharged after 2 weeks on decreasing doses of corticosteroids.

Dermatomyositis (DM) is an idiopathic inflammatory myopathy with characteristic cutaneous manifestations and systemic complications, including malignancy and interstitial lung disease (ILD). Myositis-specific autoantibodies (MSAs) define distinct disease subtypes, but significant clinical heterogeneity can still occur. Here, we report a unique case of smouldering myeloma-associated anti-nuclear matrix protein 2 (anti-NXP2) antibody-positive DM mimicking clinical features of anti-melanoma differentiation-associated gene 5 (anti-MDA5) antibody-positive DM, including digital ischemia and palmar papules (i.e. inverse Gottron's papules), and severe synovitis without clinically evident myopathy. Additionally, the patient exhibited a rare scrotal rash. This case expands the known spectrum of cutaneous and systemic manifestations in anti-NXP2 antibody-positive DM and emphasises the heterogeneous nature of DM, where significant clinical mimicry can occur despite the presence of a well-defined MSA. It highlights the need for further research into the immune mechanisms and biomarker profiles driving these mimicking DM phenotypes, which could improve early diagnosis, risk stratification, and targeted therapeutic strategies.

Extramammary Paget's disease is a rare cutaneous malignancy that typically presents as carcinoma in situ, and instances of invasive extramammary Paget's disease are exceptionally rare. Herein, we describe a rare case of invasive extramammary Paget's disease of the scrotum. A 91-year-old male presented with an over 10-year history of a granulomatous rash with serous discharge, refractory to various topical therapies and weekly wound care. Physical examination revealed a well-demarcated, erythematous, mamillated, eroded plaque with arcuate borders involving the left inguinal crease and scrotum. A punch biopsy showed intra-epidermal and invasive carcinoma with focal pagetoid spread and intracytoplasmic mucin. The favored diagnosis was primary, invasive extramammary Paget's disease. The patient underwent a wide local excision and routine imaging surveillance and remains recurrence-free at 1-year follow-up. Given that extramammary Paget's disease remains commonly misdiagnosed, leading to delays in treatment, dermatologists should be aware of this diagnosis, particularly for elderly patients presenting with non-specific genital lesions recalcitrant to routine treatment.

Leukocytoclastic vasculitis (LCV) is a small-vessel vasculitis characterized by inflammation and damage to the walls of small blood vessels. It typically presents with palpable purpura and can be associated with various systemic conditions. Although its etiology is diverse, LCV has been associated with systemic diseases, infections, medications, and autoimmune disorders. Here, we present a case of LCV in a patient with decompensated heart failure. A 58-year-old man presented with progressively deteriorating swelling in both his lower limbs and scrotum, a persistent dry cough associated with minor ulcerative lesions on his shins, and a patchy rash with pustules and flat reddish spots. He was hospitalized three days prior due to atrial fibrillation and rapid ventricular rate, for which he was commenced on amiodarone. This rash persisted for three days, yet he denied experiencing any discomfort or itchiness along with it. Based on his clinical picture, laboratory evaluations, and imaging findings, he was diagnosed with LCV induced by amiodarone.

Tucking is the gender-affirming practice of putting the penis and scrotum between the buttocks and moving the testes up into the inguinal canals. Our study explores tucking and health effects among transfeminine adults (n=79). Most (74.7%) had practiced tucking and among them, 67.2% had tucked ≥7 years. When tucking, the majority (84.5%) tucked daily and almost half (44.8%) ≥17 h/day. Half (50.0%) reported concern about the health effects of tucking. Itching, rash, and testicular pain were the most commonly reported health effects. Health care providers should use a harm reduction approach in addressing tucking-related concerns and supporting patients who tuck.