title: Case report: herpes meningitis complicating genital herpes presenting as anal fissure.
abstract: A 33-year-old woman presented with stabbing perianal pain and intermittent headache and photophobia. Examination revealed atypical multiple perianal fissures with non-specific neurological findings. Polymerase chain reaction of the perianal swab and cerebrospinal fluid examination confirmed the diagnosis of perianal herpes simplex type 2 ulcer with herpes meningitis. This report emphasizes the importance of performing further investigations on patients with atypical anal fissures with or without systemic symptoms and signs to avoid misdiagnosis, inappropriate treatment and prolonged discomfort.
authors.affiliation: Department of General Surgery, Royal Shrewsbury Hospital, Shrewsbury, West Midlands, UK. ravim1973@yahoo.co.in
authors.forename: Ravi
authors.initials: R
authors.lastname: Marudanayagam
authors.forename: Thu
authors.initials: T
authors.lastname: Linn
authors.forename: Antony D
authors.initials: AD
authors.lastname: Fox
mesh_terms: D000328:Adult; D003937:Diagnosis, Differential; D005260:Female; D005401:Fissure in Ano / Q000150:complications* / Q000175:diagnosis / Q000821:virology; D006558:Herpes Genitalis / Q000150:complications* / Q000175:diagnosis / Q000821:virology; D018258:Herpesvirus 2, Human / Q000235:genetics / Q000302:isolation & purification*; D006801:Humans; D008587:Meningitis, Viral / Q000175:diagnosis* / Q000209:etiology*; D016133:Polymerase Chain Reaction