Juvenile Gangrenous Vasculitis of the Scrotum

Abstract

A 17-year-old healthy male presented to the emergency room 
with painful black ulcers on his scrotum that developed 
acutely over 24-hours. Other symptoms included fatigue, nausea, 
and vomiting. He had a mild leukocytosis, but was afebrile. He 
continued to develop new lesions despite initiation of antibiotics at presentation. Workup was negative for herpes simplex virus 
(HSV), epstein-barr virus (EBV), human immunodeficiency virus 
(HIV), and Syphilis. A workup was initiated to rule out underlying 
vasculitis or vasculopathy , this was also negative. A shave-biopsy 
of an ulcer edge demonstrated an area of dermal necrosis associated with dense neutrophilic inflammation, hemorrhage, and intravascular thrombosis. A diagnosis of Juvenile Gangrenous Vasculitis of the Scrotum (JGVS) was made. He was treated with oral 
prednisone and immediately stopped developing new ulcers and 
showed complete resolution after 6 weeks of therapy (Figure 1).