These infections are predominately due to S. aureus but other bacteria, Candida, and herpes have also been seen. Patient histories with Job's syndrome will usually date back to early infancy. As one can imagine, treatment involves aggressive antimicrobial therapy and possibly intravenous immune globulin. The differences in this and the patient presented are the age of onset, the restricted location of the lesions to the inguinal area, and the lack of any history of sinopulmonary disease. It is most common in blacks and males, and has a worldwide distribution.
Treatment is best with doxycycline, or in children, erythromycin.
The patient presented had neither genital lesions nor adenopathy. It is caused by a gram-negative bacillus called Calymmatobacterium granulomatis however this is very rare in the United States. These painless ulcers should also be easy to distinguish from the pustular lesions of hidradenitis suppurativa. I am normally a very trusting person, but when it comes to the history of sexual activity in adolescents, I leave it in the differential just in case. Your turn You can express your views on this article, or other relevant themes, in the Infectious Diseases in Children Specialty Forums.