Clinical introduction A 37-year-old man with history of lymph node tuberculosis presented with bilateral inguinal swelling with night sweats but no fever for 2 weeks. He had a cat but he had no history of scratches. He had an extraconjugal sexual intercourse a few weeks before. Physical examination revealed 5 cm tender, erythematous and painful bilateral inguinal adenopathy (figure 1A) and a small ulceration at the base of the penis (figure 1B). Vital signs were normal.

• Download figure
• Open in new tab
• Download powerpoint

Figure 1

(A) Inguinal lymphadenopathy. (B) Ulceration at the base of the penis.

Question What is the most likely diagnosis?

1. Toxoplasmosis

2. Tuberculosis

3. Cat-scratch disease

4. Lymphogranuloma venereum

5. Syphilis