You are correct. PCR from the ulcer smear confirmed dx of HSV-2. In pts w/ HIV, the natural course of genital herpes lesions may be altered, presenting as a chronic extensive ulcer w/ hypertrophic or tumorlike lesions. This pt was treated w/ valacyclovir and referred to ID for initiation of antiretroviral tx. After 3wk, the ulcer was healed, leaving a hypopigmented macule on the dorsum of the penis.

BMJ Case Reports 2017; doi:10.1136/bcr-2017-221604

You are correct. Ion exchange chromatography from wet fabric cut from the left knee area detected the fluoride ion. Hydrofluoric acid is widely used for etching, polishing, or cleaning glass, ceramics, and walls and for removing rust. Its dissociated H⁺ ion causes skin damage and leaves the fluoride ion, which penetrates deep into the tissues, producing extensive tissue destruction. Sodium hypochlorite and potassium hydroxide are bases; however, the pH of the liquid on the trouser was 1, suggesting an acid. Strong sulfuric acid solution would result not only in coagulum formation on the skin but also break down the fabric, causing burnt holes in the clothing, but the pt’s trousers were intact. Concentrated hydrogen peroxide, a strong oxidant, could cause severe burns of the mucosa but should not damage intact skin. In this case, after irrigation, the affected skin was covered w/ calcium gluconate-soaked gauze, which drastically reduced the pain. Systemic toxicity like hyperkalemia, hypocalcemia, or hypomagnesemia was not observed, but the wound required skin grafting because of extensive tissue necrosis.

Emerg Med J 2017;34:475