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Hidradenitis Suppurativa in a Pre-Pubertal Female
Poster Abstracts
Case: We report a healthy 24-year old sexually active young woman who presented with persistent vaginal discharge and recurrent pelvic infections. Her pervious medical history was notable for right-sided renal agenesis. On sterile speculum examination, she was noted to have copious amounts of vaginal discharge. In addition, she was noted to a have cervix that was deviated to the right posterior fornix and noted to be flush against the vaginal mucosa. On bimanual examination, she was noted to have a small anteverted uterus with fullness in the right pelvis. All prior cervical cultures had been negative. A repeat PUS revealed a small 3cm uterus, poorly defined adnexa and a single left kidney. An MRI demonstrated uterine didelphysis, a vertical vaginal septum that assumed a transverse position resulting a right hydrocolpos and single left kidney. She was subsequently referred to the Center for Reproductive Medicine at the Brigham and Women’s Hospital for evaluation and surgical management. She underwent an uncomplicated single-stage vaginoplasty. Comments: The normal development of the female reproductive tract is the result of a complex series of integrated steps. Structural anomalies become clinically apparent at varying times, making the diagnosis and treatment challenging. Congenital anomalies of the genitourinary system are often associated with concomitant abnormalities of the female reproductive tract. Female patients who are known to have renal agenesis warrant a MRI to evaluate their reproductive tracts. doi:10.1016/j.jpag.2009.01.046
Hidradenitis Suppurativa in a Pre-Pubertal Female Akilah Weber-LaShore, MD, and Jill S. Huppert, MD Cincinnati Children’s Hospital Medical Center, Cincinnatti, OH
Background: Hidradenitis suppurativa (HS) is a disease of the apocrine sweat glands which causes recurrent lesions and scarring. The specific etiology and pathogenesis of HS is unknown but some believe that it is an androgen dependent acneiform eruption. Onset was initially believed to occur during late puberty or early adulthood. However, recently there have been a few reported cases of HS in prepubertal children. This is one such case. Case: The patient presented here is an 8 year old female referred to gynecology for evaluation of persistent lesions on the vulva. The patient’s mother
e53
described the lesions as ‘‘cystic acne’’ that had begun about 1 year prior to presentation. These lesions would occasionally drain and had begun to ‘‘scar’’. Cultures done by her pediatrician were reported to be negative and oral antibiotic therapy (with amoxicillin and cephalexin) prescribed previously had not been successful. The patient’s mother did not report any pubertal development such as adrenarche or growth spurt. On exam, patient was noted to have Tanner Stage I development for both breast and public hair. There was a mild amount of hirtuism noted on the upper lip, but no acne on the face or back. Additionally there were no axillary lesions or other skin changes noted. The classic follicular pustules of HS were visualized on the labia majora, as well as several erythematous papules and scarring noted on the majora and the inner creases of the thigh. There were no lesions seen on the hymen, introitus or labia minora. The patient was treated with clindamycin topical cream and sitz baths were suggested as adjunctive therapy. Initial and 2 month follow up pictures are presented. Comments: Hidradenitis suppurativa is a chronic and often distressing condition that can alter a girl’s quality of life and subject her to multiple medical and surgical treatments. Although the typical age of onset is between puberty and the second decade, there are now several case reports of pre-pubertal onset. Since HS is being diagnosed at younger ages, providers should keep this on their differential diagnosis of vulvar lesions. Furthermore, diagnosis in the prepubertal years brings to light the question of appropriate therapy in this age group particularly if antibiotic therapy unsuccessful. Finally, we wonder if the long term outcomes will differ for girls with pre-pubertal onset compared to later onset. This case helps to highlight some of the potential future areas of discussion and research concerning hidradenitis suppurativa. doi:10.1016/j.jpag.2009.01.047
Endometriomas in Adolescents Kelly Wright, MD1, and Marc Laufer, MD2 1 Department of Obstetrics and Gynecology, Brigham and Women’s Hospital, Boston, MA; 2Chief of Gynecology, Children’s Hospital Boston;Center for Reproductive Medicine, Brigham and Women’s Hospital; Obstetrics, Gynecology and Reproductive Biology, Harvard Medical School, Boston, MA
Background: Endometriomas are rare in adolescents. We report an 18 year-old presenting with
Case: We report a healthy 24-year old sexually active young woman who presented with persistent vaginal discharge and recurrent pelvic infections. Her pervious medical history was notable for right-sided renal agenesis. On sterile speculum examination, she was noted to have copious amounts of vaginal discharge. In addition, she was noted to a have cervix that was deviated to the right posterior fornix and noted to be flush against the vaginal mucosa. On bimanual examination, she was noted to have a small anteverted uterus with fullness in the right pelvis. All prior cervical cultures had been negative. A repeat PUS revealed a small 3cm uterus, poorly defined adnexa and a single left kidney. An MRI demonstrated uterine didelphysis, a vertical vaginal septum that assumed a transverse position resulting a right hydrocolpos and single left kidney. She was subsequently referred to the Center for Reproductive Medicine at the Brigham and Women’s Hospital for evaluation and surgical management. She underwent an uncomplicated single-stage vaginoplasty. Comments: The normal development of the female reproductive tract is the result of a complex series of integrated steps. Structural anomalies become clinically apparent at varying times, making the diagnosis and treatment challenging. Congenital anomalies of the genitourinary system are often associated with concomitant abnormalities of the female reproductive tract. Female patients who are known to have renal agenesis warrant a MRI to evaluate their reproductive tracts. doi:10.1016/j.jpag.2009.01.046
Hidradenitis Suppurativa in a Pre-Pubertal Female Akilah Weber-LaShore, MD, and Jill S. Huppert, MD Cincinnati Children’s Hospital Medical Center, Cincinnatti, OH
Background: Hidradenitis suppurativa (HS) is a disease of the apocrine sweat glands which causes recurrent lesions and scarring. The specific etiology and pathogenesis of HS is unknown but some believe that it is an androgen dependent acneiform eruption. Onset was initially believed to occur during late puberty or early adulthood. However, recently there have been a few reported cases of HS in prepubertal children. This is one such case. Case: The patient presented here is an 8 year old female referred to gynecology for evaluation of persistent lesions on the vulva. The patient’s mother
e53
described the lesions as ‘‘cystic acne’’ that had begun about 1 year prior to presentation. These lesions would occasionally drain and had begun to ‘‘scar’’. Cultures done by her pediatrician were reported to be negative and oral antibiotic therapy (with amoxicillin and cephalexin) prescribed previously had not been successful. The patient’s mother did not report any pubertal development such as adrenarche or growth spurt. On exam, patient was noted to have Tanner Stage I development for both breast and public hair. There was a mild amount of hirtuism noted on the upper lip, but no acne on the face or back. Additionally there were no axillary lesions or other skin changes noted. The classic follicular pustules of HS were visualized on the labia majora, as well as several erythematous papules and scarring noted on the majora and the inner creases of the thigh. There were no lesions seen on the hymen, introitus or labia minora. The patient was treated with clindamycin topical cream and sitz baths were suggested as adjunctive therapy. Initial and 2 month follow up pictures are presented. Comments: Hidradenitis suppurativa is a chronic and often distressing condition that can alter a girl’s quality of life and subject her to multiple medical and surgical treatments. Although the typical age of onset is between puberty and the second decade, there are now several case reports of pre-pubertal onset. Since HS is being diagnosed at younger ages, providers should keep this on their differential diagnosis of vulvar lesions. Furthermore, diagnosis in the prepubertal years brings to light the question of appropriate therapy in this age group particularly if antibiotic therapy unsuccessful. Finally, we wonder if the long term outcomes will differ for girls with pre-pubertal onset compared to later onset. This case helps to highlight some of the potential future areas of discussion and research concerning hidradenitis suppurativa. doi:10.1016/j.jpag.2009.01.047
Endometriomas in Adolescents Kelly Wright, MD1, and Marc Laufer, MD2 1 Department of Obstetrics and Gynecology, Brigham and Women’s Hospital, Boston, MA; 2Chief of Gynecology, Children’s Hospital Boston;Center for Reproductive Medicine, Brigham and Women’s Hospital; Obstetrics, Gynecology and Reproductive Biology, Harvard Medical School, Boston, MA
Background: Endometriomas are rare in adolescents. We report an 18 year-old presenting with