Juvenile gangrenous vasculitis of the scrotum
Fewer than 30 reports in the literature exist to date. While most reported patients were in their third decade, age range has varied between 15 and 45 years. Patients report scrotal itching, stinging, burning, or pain, which can precede or coincide with lesion presence. Patients are typically in good general health with no predisposing medical factors.
The etiology is unknown, but a number of contemporary authors believe JGV to be the male counterpart of Lipschutz ulcer. In most cases, no underlying infection can be identified; however, one case of coexisting streptococcal tonsillitis and one of acute Epstein-Barr virus infection have been reported.
JGV is self-limited, and complete resolution with mild atrophic scarring at affected sites is usually seen within 2-3 weeks.
N50.1 – Vascular disorders of male genital organs
S31.30XA – Unspecified open wound of scrotum and testes, initial encounter
9750001 – Ulcer of scrotum
Differential Diagnosis & Pitfalls
- Ulcerative herpes simplex virus infection – Seen in immunocompromised patients.
- Scrotal zoster
- Impetigo / ecthyma
- Fournier gangrene – Potentially life-threatening emergency; poorly defined, rapidly expanding cellulitis, usually seen in patients younger than 50 with concomitant diabetes and obesity.
- Genital pyoderma gangrenosum (PG)
- Warfarin necrosis
- Arthropod bite reactions – Less common on scrotum.
- Ecthyma gangrenosum – Gun-metal gray ulcer with surrounding halo of erythema; uncommon on scrotum.
- Chancroid – Soft ulcer with painful adenitis in approximately 50% of cases.
- Ulcerative colitis and Crohn disease
- Behçet disease – Screen for recurrent oral aphthosis and ocular manifestations.
- Lymphoproliferative disorders (notably, acute leukemias)
- Zipper injury
- Dermatitis artefacta