Female presents with new onset painful perineal rash associated with urinary retention and constipation. What is the diagnosis?

The rash:


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HSV-2 sacral radiculitis (Elsberg syndrome). Aside from urinary retention and constipation, other symptoms can include erectile dysfunction, dull pain in the anogenital region, paresthesias, loss of sensation, or flaccid paresis of leg muscles. CSF shows mild to moderate lymphocytic pleocytosis with minor elevation of CSF protein. PCR analysis or culture of CSF may be HSV positive. MRI may show varying degrees of root or lower spinal cord edema. Remission of symptoms is mostly complete in milder cases after one to several weeks. Antiviral treatment may shorten the symptomatic period.


Source

Eberhardt, O., Kuker, W., Dichgans, J., and Weller, M. "HSV-2 sacral radiculitis (Elsberg syndrome)" Neurology Aug 2004.

Selius, B. and Subedi, R. "Urinary Retention in Adults: Diagnosis and Initial Management" American Family Physician. 1 March 2008.

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