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Recidivant skin coccigeal lesion
Jul 1, 2011

Sir, i am an italian doctor, 49yo, HIV+ since 1987.

During years i experimented all possible medical drugs for my disease, with actual 0 viral load and very good quality of life.Except for one thing: an exuding skin lesion. It is recurrent in the same area ( sacral-coccygeal skin area). It tends to increase theexuding, inflammation and size. It is still there.for the umpteenth time, and after a biopsy and two radical excisions , and showing no signs at all to heal. The features are exactly the same as all other lesions that I have persecuted in the past 7-8 years. In early onset it looks like a small subcutaneous swelling, with itching and mild discomfort. The onset was almost always resulting in stress and symptoms suggesting a pseudo-herpetic event . Neither acyclovir nor its alternatives molecules, or antibiotics, or antiviral ganciclovir, however, have never had any effect on the course.

These small cysts opened eventually to the outside constantly releasing exudative material but never pus.

The first biopsy showed no specific granulomatous tissue characteristics and was positive for herpes simplex virus type II. At first, these lesions had a down trend and often regressed completely, leaving the skin intact. Following the incidents have increased both as frequency and duration. In the last three years has never occurred any regression until surgical excision.

The first surgery was performed at Rome Policlinico Gemelli's plastic surgery and the anatomical part has been analyzed at the local service Of anatomy and pathological histology of Prof. Massi. Histology one more time showed nonspecific inflammatory material.

The recurrence after the first surgery was almost immediate and the lesion has reached the size of an apricot in the space of a year.

[IMG]http://i140.photobucket.com/albums/r29/surfista38/P9290020.jpg[/IMG]

[IMG]http://i140.photobucket.com/albums/r29/surfista38/P9290019.jpg[/IMG]

Last October 2010, the recurrent lesion was completely excised , with a wide margin of healthy skin and for this reason it was necessary a reconstruction with a rotation skin flap. Histological examination again showed only nonspecific inflammatory granulomatous tissue with small areas of necrosis.

Since two months symptoms started again, just below the margin bottom of the scar with the presence of two small ulcers exuding, which are flowing and gradually assuming the usual characteristics of previous granulomatous lesions

[IMG]http://i140.photobucket.com/albums/r29/surfista38/IMG_0471.jpg[/IMG]

[IMG]http://i140.photobucket.com/albums/r29/surfista38/IMG_0470.jpg[/IMG]

You can imagine how desperate I am, because nobody can find a diagnosis and the only suggestion is a re-surgery. Do you have any experience of case hystory like mine?

Response from Dr. Henry

I have observed several patients with recurrent coccyx region skin lesions similar to what you have described-as with your own experience a diagnosis of herpes-like lesions has been used but is unsatisfactory. I dont have any great insights-if any reader wishes to comment please do so. Coccygeal hernia, pilonidal abnormalities, and other rare conditions in that region can be tough to diagnose/manage without help of expert in that field. KH



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