Vaginal Ulceration and Local Lymphadenopathy in an African Immigrant

Immunohistochemical stain for lysozyme of a biopsy speci-men obtained from the vaginal ulceration (original magnication, 240).A 34-year-old African woman from Togo presented at ouroutpatient clinic with an ulcerous lesion ∼1 cm in diameter atthe posterior commissure of the vulva, which was detected inthe course of a curettage after termination of pregnancy in theseventh week. The case history included HIV infection diag-nosed when the patient immigrated to Germany, 8 years beforepresentation. The physical examination revealed swollen in-guinal lymph nodes, but ndings were otherwise normal. Thepatient reported that she had noticed the lesion for the rsttime 3 months before presentation.Ultrasound, CT, and MRI of the abdomen revealed patho-logical lymph node swelling up to 3.5 cm in diameter in theparaaortal, mesenterial, inguinal, and iliacal regions on bothsides. The ndings of the chest radiograph were normal.Analysis of a biopsy sample obtained from the vaginal ul-ceration revealed an ulcerous granulomatous inammationwith multinucleated giant cells enclosing numerousglobuliwitha diameter of 10–14 mm and a periodic acid Schiff–positivesheath (gures 1 and 2). These cytoplasmatic enclosures werealso seen on Grocott staining (gure 3).