Scrotal Ulcer Research Articles

Cutaneous metastasis: A rare presentation of prostate cancer.

We report an 81-year-old man who presented with an ulcerated nodule on the anterior scrotum. Histological analysis identified this to be a cutaneous metastasis of previously treated prostate adenocarcinoma. We also reviewed the literature on cutaneous metastasis of visceral malignancies, as well as differential diagnoses for scrotal nodules and ulceration.

A new nomogram based on ultrasound and clinical features for distinguishing epididymal tuberculosis and nontuberculous epididymitis

Using ultrasound findings and clinical characteristics, we constructed and validated a new nomogram for distinguishing epididymal tuberculosis from nontuberculous epididymitis, both of which share similar symptoms. We retrospectively examined data of patients with epididymal tuberculosis and nontuberculous epididymitis hospitalized between January 1, 2013, and March 31, 2023. Eligible patients were randomly assigned to derivation and validation cohorts (ratio, 7:3). We drew a nomogram to construct a diagnostic model through multivariate logistic regression and visualize the model. We used concordance index, calibration plots, and decision curve analysis to assess the discrimination, calibration, and clinical usefulness of the nomogram, respectively. In this study, 136 participants had epididymal tuberculosis and 79 had nontuberculous epididymitis. Five variables—C-reactive protein level, elevated scrotal skin temperature, nodular lesion, chronic infection, and scrotal skin ulceration—were significant and used to construct the nomogram. Concordance indices of the derivation and validation cohorts were 0.95 and 0.96, respectively (95% confidence intervals, 0.91–0.98 and 0.92–1.00, respectively). Decision curve analysis of this nomogram revealed that it helped differentiate epididymal tuberculosis from nontuberculous epididymitis. This nomogram may help clinicians distinguish between epididymal tuberculosis and nontuberculous epididymitis, thereby increasing diagnosis accuracy.

Undiagnosed Behçet’s disease presenting as Fournier’s gangrene in undiagnosed Behçet’s disease: a case report of a young adult male

Introduction and importance: Behçet’s disease is a rare systemic condition, with the mean age of patients being ~30 years. It affects men more than women. Behçet’s disease should be considered in any patient with a systemic inflammatory disease characterized by recurrent orogenital ulcers and uveitis. Fournier’s gangrene is a rare life-threatening bacterial genital infection that acquires at any age with male predominance. Case presentation: A healthy 32-year-old male presented with fatigue, fever, oral ulcers, and discrete scrotal ulcers. He had Fournier’s gangrene and a new diagnosis of Behçet’s disease. He was treated with intravenous antibiotics with surgical debridement. Before discharge, the patient was commenced on 1 mg/day of colchicine. During the follow-up visits, we noted small ulcerations without necrosis on the scrotum, which we started with oral prednisolone and oral methotrexate. He remains under their care 6 months later. Clinical discussion: The patient had recurrent oral ulcerations followed by genital aphthous ulceration and acneiform eruptions that met Behçet’s diagnosing criteria. Fournier’s gangrene on the scrotum was diagnosed due to the physical examination, radiological findings, and histological findings. A PubMed search reveals one similar case report. This patient’s only risk factor for Bechet’s was his ethnicity and male gender for Fournier’s gangrene. Conclusion: The young adult patient presented unusually, with a diagnosis of Fournier’s gangrene superimposed on undiagnosed Behçet’s disease. An understanding of the epidemiology and risk factors can help in the diagnosis of these rare pathologies.

A rare incidence of severe dermatological toxicities triggered by concomitant administration of all-trans retinoic acid and triazole antifungal in patients with acute promyelocytic leukemia: a case series and review of the literature

BackgroundAll-trans retinoic acid (ATRA) is an indispensable part of the treatment of acute promyelocytic leukemia (APL). Although, mild cutaneous toxicities like mucocutaneous xerosis, rash, and pruritus are well reported, ATRA associated severe dermatological toxicities are extremely rare. ATRA is primary metabolized by cytochrome P450 (CYP450) enzyme system, and triazole antifungals are notorious for their strong inhibitory effect on CYP450.Case presentationThree Asian APL patients experienced rare ATRA-induced severe dermatological toxicities: exfoliative dermatitis (ED) in cases 1 and 2, and necrotic scrotal ulceration in case 3. Both case 1 (33-year-old female), and case 2 (28-year-old male) landed in emergency department with dehydration, generalized skin erythema and xerosis during their induction chemotherapy. Both of these patients also developed invasive aspergillosis and required concomitant triazole antifungals during their chemotherapy. For ED, intravenous fluids and broad-spectrum antibiotics were started along with application of local emollients to prevent transdermal water loss. Although their general condition improved but skin exfoliation continued with complete desquamation of palms and soles. Dermatology was consulted, and clinical diagnosis of ED was established. Discontinuation of ATRA resulted in complete resolution of ED. Case 3 (15-year-old boy) reported two blackish mildly tender scrotal lesions during induction chemotherapy. He also had mucocutaneous candidiasis at presentation and was kept on triazole antifungal. Local bacterial & fungal cultures, and serological testing for herpes simplex virus were reported negative. Despite adequate local care and optimal antibiotic support, his lesions persisted, and improved only after temporary discontinuation of ATRA. After a thorough literature review and considering the temporal association of cutaneous toxicities with triazole antifungals, we speculate that the concomitant use of triazole antifungals inhibited the hepatic metabolism of ATRA, resulting in higher serum ATRA concentration, and markedly accentuated cutaneous toxicities in our patients.ConclusionBy highlighting this crucial pharmacokinetic interaction, we want to caution the fellow oncologists to be mindful of the inhibitory effect of triazole antifungals on CYP450. We propose using a non-myelosuppressive combination of ATRA and arsenic trioxide for management of APL hence, obliterating the need of prophylactic antifungals. However, in the event of invasive fungal infection (IFI), we suggest using alternative class of antifungals.

(133) Non-Occupational SCC of the Scrotum; Case Presentation and Management

Abstract Introduction Although the incidence of scrotal malignancies is extremely low Squamous cell carcinoma (SCC) is the most common scrotal malignancy. Its overall annual incidence is approximately 1.5 per 1,000,000 persons in Western countries. It was first linked to the chronic irritation of scrotal skin by the effect of soot in occurring in chimney sweepers hence known as the first described occupational disease. Occupational scrotal SCC was also later described in association with other occupations with chronic carcinogen exposure including cotton mule spinners, paraffin and tar workers, creosote workers, shale oil workers, lathe workers, pitch workers and machine tool setters and operators. Currently most cases result from poor hygiene and chronic inflammation Objective Herein we present a very rare case of SCC of the scrotum referred to us from Dermatology department Methods This 55 years old male patient was referred from dermatology department. He had no underlying occupational hazard. He has been treated for several months of itchy inflammation of the scrotumfor 6 months. Scrotal punch biosy showed moderately differentiated SCC. Clinically there was malignant scrotal ulcer of 4x3 cm with no palpable inguinal lymph nodes. CT staging confirmed localized tumor with no LN or metastatic deposits. Complete excision with 2 cm safety margin confirmed to be negative by frozen section. Final histopathology come to be moderately differentiated SCC pT2Nx. All margins and underlying Dartos were free of tumor infiltration. Results Complete excision could be achieved with intra-operative negative frozen section. Uneventful post-operative course with complete healing of scrotal wound. Conclusions Although rare, scrotal SCC continues to be serious urogenital malignancy which should be suspected even in the absence of occupational exposure. Cooperation and awareness of Dermatologists is important for early detection and management of such rare malignancy. Complete excision with safety margin is usually sufficient for cure. Inguinal Lymphadenectomy is indicated if grossly infiltrated Disclosure No.

Penis sparing scrotal ulcerations by herpes simplex virus 2 in an immunocompetent patient

Penis sparing scrotal ulcerations by herpes simplex virus 2 in an immunocompetent patient

Comparison of Serum Levels of SIL-2R, IL-6, IL-10, TNF-α, CRP, ESR and Fibrinogen in Patients with Active and Inactive Behçet’s Disease

Behçet's disease (BD) is a chronic inflammatory illness that affects the entire body and is characterized by recurring episodes of oral aphthae, ocular and cutaneous lesions, and scrotal or vaginal ulcerations. The involvement of other organs and systems increases mortality in addition to the significant morbidity. This study involved a total of 40 participants, 20 of whom were healthy controls and 20 of whom were patients (of the 20 Behçet's patients, 12 (60%) were in the active phase and 8 (40%) were in the inactive phase). There was no therapy being given to any of the 20 patients that would have affected their cytokine levels. Only young men made up the patient and control groups because both early onset and male sex are signs of poor prognosis. The ELISA method was used to measure the levels of serum cytokines. The statistical analysis of the derived numerical values employed the Mann-Whitney U Test. We found a significant correlation between serum cytokine levels and classical acute phase markers in active Behçet’s patients. ESR (P < 0,001), CRP (P < 0,001), fibrinogen (P < 0,001), IL-10 (P < 0,001), IL-6 (P < 0,001), SIL-2R (P < 0,001) and TNFα (P < 0,001). There was no statistically significant difference in serum levels of classical acute phase markers ESR (P = 0,746), CRP (P = 0,476) and fibrinogen (P = 0,940) when inactive Behçet’s patients and healthy controls were compared. However, serum levels of IL-10 (P < 0,001), IL-6 (P = 0,001), SIL-2R (P < 0,001) and TNFα (P = 0,001) were statistically different between inactive Behcet's patients and the control group. Our research shows that even in the inactive phase, serum cytokine levels of Behçet’s patients are much higher than the healthy control group. However, the levels of ESR, CRP and fibrinogen, which are classical acute phase markers, were found at normal levels in Behçet’s patients in the inactive phase. These findings show that measurement of serum interleukin levels will enable us to take preventive measures for morbidity and mortality follow-up of Behçet's patients.

Tuberculous Epididymitis Treatement as Acute Scrotal Abscess

Objective: Tuberculous epididymis TB introduced as a colossal scrotal ulcer with scrotal sack inclusion is extraordinarily remarkable. The side effects of such ITE look like the epididymo-orchitis or dangerous tumor, which results in misdiagnosis or defer in conclusion. Methods: This study is a review information examination of 16 instances of histologically-affirmed epididymal tuberculosis in patients treated at IBN-SINA medical clinic from March 2015 to December 2022. Results: The age of the patients was normal around 42 years (range, 24-62 years); 5 patients (31.25%) had tuberculosis in the left epididymis, 7 patients (43.75%) had tuberculosis in the right epididymis and 4 patients (25%) had two-sided epididymal tuberculosis. Of the 16 patients, 3 patients (18.75%) had a past filled with tuberculosis, including 1 instance of pneumonic tuberculosis, 1 instances of renal tuberculosis and one instance of prostate tuberculosis. Conclusion: Epididymal tuberculosis is probably going to have attacked encompassing tissues when signs, for example, epididymal beaded changes and not well characterized epididymis-testis line are available. Careful treatment joined with preoperative and postoperative anti-tubercular treatment is a successful way to deal with treating this condition. Sperm retrieval and cryopreservation must be considered for potential intra-cytoplasmic sperm infusion.

Tyrosine Kinase Inhibitors Induced Scrotal Ulcerations: Report of 2 Cases.

Tyrosine Kinase Inhibitors Induced Scrotal Ulcerations: Report of 2 Cases.

Juvenile gangrenous vasculitis of the scrotum: systematic review

Juvenile gangrenous vasculitis of the scrotum (JGVS) is a rare entity with scant reports in the literature. The disease course, treatment, and prevalence have not been well described in the literature. It's hypothesized that JGVS is a variant of pyoderma gangrenosum or a male counterpart of Lipschütz ulcer. This review will analyze the current literature on JGVS and provide a current guide based on the best available data. The initial search of databases yielded 107 studies of which 14 pertained to the topic. The majority of the included studies were case reports (n = 9) reported in Spain. A total of 17 patients were included in the study. The mean age of patients was 22.45 years (range, 13-35 years). The majority of patients presented with multiple, acute, painful, well-circumscribed, round scrotal ulcerations. The majority of patients presented with flu-like symptoms. An increased level of awareness of JGVS diagnosis is now warranted among physicians. Despite the analogies with Lipschütz ulcer, we believe that JGVS is a distinct entity.

A real-world pharmacovigilance study of axitinib: data mining of the public version of FDA adverse event reporting system

ABSTRACT Background Axitinib was approved for treatment of advanced renal cell carcinoma (RCC). The current study was to assess axitinib-related adverse events (AEs) through data mining of the US Food and Drug Administration Adverse Event Reporting System (FAERS). Methods Disproportionality analyses, including the reporting odds ratio (ROR), the proportional reporting ratio (PRR), the Bayesian confidence propagation neural network (BCPNN), and the multi-item gamma Poisson shrinker (MGPS) algorithms, were employed to quantify the signals of axitinib-associated AEs. Results Out of 10,703,806 reports collected from the FAERS database, 9044 reports of axitinib as the ‘primary suspected (PS)’ AEs were identified. Axitinib induced AEs occurrence targeted 26 organ systems. A total of 95 significant disproportionality PTs conforming to the four algorithms were simultaneously retained. Rare reports and significant signals of aortic disease have emerged. Unexpected significant AEs such as scrotal swelling, scrotal ulcers, infections, and infestations might also occur. The median onset time of axitinib-associated AEs was 63.5 days (interquartile range [IQR] 20–182 days), and most of the cases occurred within the first one and 2 months after axitinib initiation. Conclusion Our study found potential new AEs signals and might provide important support for clinical monitoring and risk identification of axitinib.

Behcet’s disease (Silk Road disease): a rare inflammatory disease

Background: Behcet’s disease (Silk Road disease), a rare immune-mediated multisystem inflammatory disorder described by intermittent oralaphthae and genital ulcer, backsliding uveitis, mucocutaneous, articular, gastrointestinal, neurological and vascular manifestations, with no cure.It is brought about by changes in the: a) arteries that flexibly blood to the body tissues b) veins that return the blood to the lungs, the rear of the eyes retina, brain, joints, skin and bowels.
 Case Presentation: A 55-year-old male patient was sensed with c/o joint agony in lower appendages, oral ulcer and scrotal ulcer. On physical assessment the patient was cognizant and oriented with B/L lower leg joint emanation. All lab examination including RA factor was within normal limits, with diminished Serum Vitamin D. HLA B51, ANA were checked and oral mucosal biopsy was done. The most punctual sign exhibited was oral disintegration, various shallow ulcer and scarcely any dissolved knobs in the scrotum. At that point the patient gave joint pain and numbness on right leg. On neurological assessment, a strange motor nerve conduction saw with right tibial neuropathy. At first, doubt with syphilis and tarsal tunnel disorder and following 7-8 days of affirmation, analyzed as Behcet's illness dependent on dermatological, rheumatologic and neurological signs. Treatment given was symptomatic and supportive with pain relievers, corticosteroid, antibiotics, IV fluids, PPI, vitamin supplement, laxative and local anaesthetic.
 Discussion:Without adequate data it's difficult to examine, in light of anomaly and standardized treatment are questionable at present. New information with respect to its immunopathogenesis, genetics will significantly help in the advancement of research center tests, diagnostic criteria and particularly in the decision of the best treatment

Scrotal Ulcer is a Rare Presentationof TB Epididymis in Young Male

Introduction: Scrotal tuberculosis (TB) is rare and may present as painful scrotal swelling with ulceration and discharging sinus.
 Case Report: A 28 years male with 2 months history of swelling and pain over left scrotum. Developed ulcer over the scrotal region with multiple sinus associated with pus discharge.
 Conclusion: The clinical presentation of TB scrotal ulcer can be atypical and a high index of suspicion is required for early diagnosis. Diagnosis is by using ultrasonography, microbiology, and biopsy. Treatment requires prolonged ATT for 6 months.

Juvenile Gangrenous Vasculitis of the Scrotum: A Case to Consider

We present the case of a 27-year-old male patient who presented with fever and scrotal ulcer after pharyngotonsillar symptoms. The differential diagnosis with other entities that present with scrotal ulcer is proposed, including Fournier's gangrene and vascular ulcer secondary to infection by the SARS-CoV-2 virus.

Giant Inguinoscrotal hernia -a radiological perspective

Inguinal hernia is a common surgical disease. Giant inguinoscrotal hernias are more unusual and impose significant impact on quality of life including difficulty with mobility, scrotal skin ulceration and bowel obstruction. Besides it is more challenging in terms of surgical management. Diagnosis of giant inguinoscrotal hernia is straight forward on clinical examination. Nevertheless, with the advent of CT scan, pre-operative contrast-enhanced CT scan is useful for ascertaining the hernia contents, its configuration and measuring the neck of hernia. We report a case of a patient with extremely huge irreducible right giant inguinoscrotal hernias.

Delayed genital necrosis after cytoreductive surgery and hyperthermic intraperitoneal chemotherapy with Mitomycin-C

IntroductionGenital necrosis (GN) is a rare complication of cytoreductive surgery with hyperthermic intraoperative chemotherapy (CRS/HIPEC) which can be confused with necrotizing fasciitis. We present an analysis of GN after CRS/HIPEC to define its natural history. MethodsWe identified patients with GN after CRS/HIPEC at two peritoneal surface malignancy institutions. Patient demographic, surgical, and postoperative data were extracted from prospective databases. ResultsOf 1597 CRS/HIPECs performed, 13 patients (0.8%) had GN. The median age was 57 years (IQR: 49–64) and 77% (n = 10) were male. Mitomycin-C was the perfusion agent in all cases of GN (100%). The median time to GN onset after CRS/HIPEC was 64 days (IQR: 60–108) and 2 (15%) patients were receiving systemic chemotherapy at the time of GN onset. Symptoms included severe pain (100%), edema (100%), labial or scrotal skin ulceration (92%), signs of infection (39%), and fever (15%). Seven (54%) patients had thrombocytosis >400 ∗109/L, whereas coagulation tests were within normal reference range in 100% cases. All patients initially underwent conservative treatment, with antibiotic therapy administered in 62% (n = 8). Surgical debridement was performed in 9 (70%) cases with median time after GN onset of 57 (IQR: 8–180). ConclusionGN is a debilitating complication after CRS/HIPEC with delayed onset and a protracted clinical course. Optimal treatment results could be achieved with initial conservative management until complete lesion demarcation followed by surgical debridement. The pathophysiology of GN is unclear, and we call for other researchers attention to better understand the complication and prevention.

Pyoderma gangrenosum and cobalamin deficiency in systemic lupus erythematosus: a rare but non fortuitous association

BackgroundPyoderma gangrenosum (PG) is an uncommon, idiopathic, ulcerative neutrophilic dermatosis. In many cases, PG is associated with a wide variety of different disorders but SLE in association with PG is relatively uncommon. In this article we present the case of a middle aged patient with PG as the initial clinical presentation of SLE. We also provide a brief review of cobalamin deficiency which occurred in our patient and evidence-based management options.Case presentationA 35 years old man presented with a 5 month history of debilitating painful lower limb and scrotal ulcers. This was associated with polyarthralgia and morning stiffness involving both hands. He also complained of swallowing difficulties. He had unintentional weight loss of 10 kg and fatigue. Physical examination revealed alopecia, multiple cervical lymphadenopathies, bilateral parotid gland enlargement and atrophic glossitis. There was Raynaud’s phenomenon noted over both hands and generalised hyper-pigmented fragile skin. Laboratory results disclosed anaemia, leukopenia, hyponatraemia and hypocortisolism. Detailed anaemic workup revealed low serum ferritin and cobalamin level. The autoimmune screen showed positive ANA, anti SmD1, anti SS-A/Ro 52, anti SSA/Ro 60, anti U1-snRNP with low complement levels. Upper gastrointestinal endoscopy with biopsies confirmed atrophic gastritis and duodenitis. Intrinsic factor antibodies and anti-tissue transglutaminase IgA were all negative. Punch biopsies of the leg ulcer showed neutrophilic dermatosis consistent with pyoderma gangrenosum. Based on the clinical findings and positive immunologic studies, he was diagnosed as systemic lupus erythematosus. His general condition improved substantially with commencement of corticosteroids, immunosuppressants and vitamin supplements.ConclusionsWe report a case of PG as the first manifestation of SLE which was treated successfully with immunosuppressants and vitamin supplements. Our report highlighted the need to consider connective tissue diseases such as SLE in a patient presenting with PG in order for appropriate treatment to be instituted thereby achieving a good outcome.

Case Series of Testicular Tuberculosis in Calabar, South- South Nigeria

Introduction: Bilateral testicular tuberculosis should be considered as an important differential of testicularswelling and scrotal ulcer in a country like Nigeria with high burden of tuberculosis infection.Case Reports: Here we present three cases of negroid male ranging in age from 39 years to 70 years whohad orchidectomy on account of testicular malignancy that turn out to be genital tuberculosis which wasdiagnosed histologically.Conclusion: Private medical practitioner in low income countries and in region of high tuberculosis burdenshould always have a high index of suspicions for tuberculosis in patients presenting with scrotal ulcers ortesticular swelling that fails to respond to antibiotics therapy. Adequate evaluation of patients with testicularswelling and ulcer by means of abdominal and scrotal ultrasound, bacteriological studies and PCR iscritical to diagnostic accuracy, optimal treatment and possibility of avoiding surgery in those with testiculartuberculosis and guiding against litigation.

Bechet’s Disease and its association with Herpes Simplex Virus : Case Report of a rare Multisystem disorder with review of the literature

In the year 1937, A Turkish dermatologist Prof Hulusi Bechet described a syndrome based upon three cases. His first reported case in the year 1924 was a female who presented with recurrent aphthous ulcers of the oral cavity, genital ulcers, erythema nodosum and visual impairment which later lead to blindness. The second patient presented in 1930 with oro-genital ulcerations and scleral injection in the eyes. The third case was reported in the year 1936, a male which similar complaints, scrotal ulcers, loss of vision, scleral injection, fever and myalgia. Professor Hulusi Bechet grouped these clinical findings into a syndrome known as Bechet’s syndrome. Bechet's disease may present in several ways, and many patients' oral ulcers are the presenting complaints. Oral ulcers are usually underdiagnosed and often ignored by the patients. Later on, genital ulcers and complications such as Uveitis appear, which cause the patients to seek medical help. This is a rare disorder, but it must be considered as the complications may lead to a permanent impairment of vision.In many cases and studies, Bechet's disease is associated with the Herpes simplex virus. The evidence that we report is also found to have positive antibodies for Herpes simplex virus. Herpes Simplex Virus is a DNA Virus and is a causative agent in various ocular diseases such as conjunctivitis, corneal ulceration, stromal keratitis, scleritis iridocyclitis, Uveitis. On an average HSV Uveitis occurs at the age of 46 years. Herpetic corneal ulceration is a cause of blindness in these patients. Bechet's disease is also associated with Uveitis and has a dreaded complication of blindness. The patient that we report had both oral ulceration, genital ulceration, Uveitis and was found to have HSV antibodies. Management and treatment must reduce relapses.

EXTENSIVE DVT IN A YOUNG MALE WITH PERSISTENT SCROTAL INFECTIONS

SESSION TITLE: Medical Student/Resident Procedures Posters SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: October 18-21, 2020 INTRODUCTION: Deep vein thrombosis (DVT) in young adults is uncommon but can be associated with significant morbidity. DVT is often idiopathic but genetic risk factors may play a role. We report a case of extensive DVT of the common iliac veins, inferior vena cava (IVC) and renal veins in a young man without common risk factors. CASE PRESENTATION: 19 year old African American male was admitted in October 2019 with scrotal pain, dyspnea, palpitations, fatigue, fever with chills and non-bloody diarrhea. He was on antibiotics 3 weeks prior to admission for recurrent scrotal infection. In July 2019, he had left sided scrotal pain and swelling treated with incision and drainage followed by multiple antibiotic courses. The patient had no prior history of venous thromboembolism, smoking, or family history of blood clots. Physical exam findings showed ill looking male with mild hypotension and scrotal ulcerations. Labs were significant for lactic acidosis, acute kidney injury, anemia and coagulopathy. Scrotal Ultrasound showed no abscess or torsion. Computed Tomography (CT) of abdomen and pelvis revealed extensive thrombosis of the renal veins, inferior vena cava (IVC) and common iliac veins, along with bilateral lower lobe pulmonary emboli and small pulmonary infarctions. Echocardiogram did not show any right heart strain. He was started on systemic anticoagulation, broad-spectrum antibiotics, intravenous fluids and vasopressor therapy. Vascular surgery and interventional radiology were consulted. Mechanical thrombectomy of the IVC was performed with extensive thrombi removal and restoration of IVC patency. His wound cultures grew Methicillin-resistant Staphylococcus aureus and Pseudomonas aeruginosa resistant to fluoroquinolones. On discharge, he was treated with apixaban for 3 months and aspirin for 4 weeks with a close outpatient follow-up in 1 month. DISCUSSION: DVT in young male is uncommon with a wide differential. Scrotal ulcers can be associated with local thrombosis and extension into the iliac veins based on the anatomic drainage. Management of extensive thrombosis of the venous system can be challenging. CONCLUSIONS: Combination of mechanical thrombectomy and anticoagulation with antiplatelet therapy was effectively utilized to address the extensive thrombosis. Drainage and medical management of scrotal ulcers addressed the underlying etiology of the thrombosis. Reference #1: Cushman, M. (2007). Epidemiology and Risk Factors for Venous Thrombosis. Seminars in Hematology, 44(2), 62–69. doi:10.1053/j.seminhematol.2007.02.004 DISCLOSURES: No relevant relationships by Asok Dasgupta, source=Web Response No relevant relationships by Reed Geisler, source=Web Response No relevant relationships by Ty Gilkey, source=Web Response No relevant relationships by Chelsea Leipold, source=Web Response No relevant relationships by Nicholas Romano, source=Web Response No relevant relationships by Paresh Timbadia, source=Web Response