u/Any-Local-6568

Hello everyone on DiagnoseMe!

I (39M) have a case that started with a minor local infection/injury but has since "climbed" my body/nervous system, resulting in a systemic mess. Despite my body feeling like it’s under siege, GP and urologist still clueless due to "perfect" lab results.

I am looking for ideas for upcoming appointments with a dermatologist and my GP.

Timeline & Progression:

• Onset: It began 3 months ago with a small wound and redness on the foreskin (prepuce) following a minor injury and a period of suboptimal hygiene.
• Evolution: I had the sensation of the inflammation "moving inward." This was followed by burning pain in the bladder area and 2 weeks later in the sacral area
• Current Status (Systemic & Local):
  1. Foreskin Changes: Persistent ring-shaped redness at the tip (~1cm), significant loss of elasticity, too narrow in retracted position (phimosis) but doesn't tighten as usual in "normal" position.
  2. Headaches: Now a permanent, daily condition (initially only on the top of the head).
  3. Lymph Nodes: Constant, dull pain in the inguinal (groin) lymph nodes for over a month.
  4. Bladder: Occasional discomfort in the bladder area, although the urologist confirmed the bladder empties completely.
  5. Sacral Pain: burning has subsided but remains a relevant part of the clinical picture.

Diagnostics so far:

• Blood work: Comprehensive analysis (including inflammatory markers) showed no abnormalities
• Urinalysis & Cultures: A simple urine test was performed immediately following the onset of bladder symptoms. Two weeks later, a formal urine culture was conducted (only incubated for 2 days). Both were negative for bacteria or signs of infection.
• Urology: Cystoscopy and ultrasound were completely normal.
• Clinical finding: The urologist confirmed the pathological changes to the foreskin but could diagnose it and forwarded me to a dermatologist.

For Context:

• No sexual contact in the last 6 months.
• No fever at any point.
• History of minor athlete’s foot (left foot) and a herpes blister on the lip at the time of onset. (my GP considers both not relevant/unrelated)

To date, I received no targeted treatment, only pain therapy. I already feel a little hopeless. The next step is an appointment with a dermatologist in 3 weeks.

My Questions:

1. What conditions could explain a localized skin injury/infection leading to chronic inguinal lymph node pain and permanent headaches?
2. Are there specific dermatological or systemic conditions (e.g., autoimmune or rare pathogens) that could cause these skin changes and systemic symptoms without appearing in standard blood work or urinalysis?
3. What diagnostic steps or specialized tests (e.g., specific swabs, PCR tests) would you suggest discussing with a dermatologist or GP next?

Thank You!