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Vulvar edema and weight loss in a pediatric patient
Vulvar edema and weight loss in a pediatric patient Angela S. Gupta, BS, Patricia W. O’Connor, MD, and Alex G. Ortega-Loayza, MD Richmond, Virginia
From the Department of Dermatology, Virginia Commonwealth University, Richmond, Virginia. Funding sources: None. Conflicts of interest: None declared. Correspondence to: Alex G. Ortega-Loayza, MD, Department of Dermatology, Virginia Commonwealth University, 401 N 11th St,
Nelson Clinic, 5th fl, Ste 520, Richmond, VA 23219. E-mail: alex. [email protected]. J Am Acad Dermatol 2015;73:e193-4. 0190-9622/$36.00 ª 2015 by the American Academy of Dermatology, Inc. http://dx.doi.org/10.1016/j.jaad.2015.08.002
e193
e194 Gupta, O’Connor, and Ortega-Loayza
J AM ACAD DERMATOL
DECEMBER 2015
A 12-year-old African American female presented with significant weight loss and vaginal pain. The physical examination revealed extreme vulvar swelling and anal fissuring but normal vaginal and cervical mucosa (Fig 1). Blood testing was significant for anemia, thrombocytosis, low albumin, and elevated inflammatory markers. The infectious workup was negative except for methicillin-sensitive Staphylococcus aureus on superficial wound culture. Skin biopsy specimens of the labia were obtained (Fig 2) and prompted additional endoscopic evaluation. Her esophagus, stomach, duodenum, and colon were grossly normal; however, biopsy specimens of the colon revealed the same histopathology as the labia. In addition, an abdominal computed tomography scan revealed wall thickening and increased mucosal enhancement (Fig 3). 1.
What is the most likely diagnosis? A. Cutaneous Crohn’s disease B. Behc¸et disease C. Mycobacterial infection D. Foreign body reaction E. Hidradenitis suppurativa
2.
What is the characteristic histopathologic finding for this condition? A. Necrotizing granulomas B. Noncaseating granulomas C. Perivascular lymphocytic infiltration D. Positive acid-fast stain E. Positive methenamine silver stain
3.
What is the most appropriate course of treatment? A. Rifampin and ethambutol B. Surgical debridement C. Topical steroids only D. Oral steroids, azathioprine, metronidazole, or infliximab E. No treatment, will regress spontaneously Please visit http://www.eblueimages.org to answer these questions.
From the Department of Dermatology, Virginia Commonwealth University, Richmond, Virginia. Funding sources: None. Conflicts of interest: None declared. Correspondence to: Alex G. Ortega-Loayza, MD, Department of Dermatology, Virginia Commonwealth University, 401 N 11th St,
Nelson Clinic, 5th fl, Ste 520, Richmond, VA 23219. E-mail: alex. [email protected]. J Am Acad Dermatol 2015;73:e193-4. 0190-9622/$36.00 ª 2015 by the American Academy of Dermatology, Inc. http://dx.doi.org/10.1016/j.jaad.2015.08.002
e193
e194 Gupta, O’Connor, and Ortega-Loayza
J AM ACAD DERMATOL
DECEMBER 2015
A 12-year-old African American female presented with significant weight loss and vaginal pain. The physical examination revealed extreme vulvar swelling and anal fissuring but normal vaginal and cervical mucosa (Fig 1). Blood testing was significant for anemia, thrombocytosis, low albumin, and elevated inflammatory markers. The infectious workup was negative except for methicillin-sensitive Staphylococcus aureus on superficial wound culture. Skin biopsy specimens of the labia were obtained (Fig 2) and prompted additional endoscopic evaluation. Her esophagus, stomach, duodenum, and colon were grossly normal; however, biopsy specimens of the colon revealed the same histopathology as the labia. In addition, an abdominal computed tomography scan revealed wall thickening and increased mucosal enhancement (Fig 3). 1.
What is the most likely diagnosis? A. Cutaneous Crohn’s disease B. Behc¸et disease C. Mycobacterial infection D. Foreign body reaction E. Hidradenitis suppurativa
2.
What is the characteristic histopathologic finding for this condition? A. Necrotizing granulomas B. Noncaseating granulomas C. Perivascular lymphocytic infiltration D. Positive acid-fast stain E. Positive methenamine silver stain
3.
What is the most appropriate course of treatment? A. Rifampin and ethambutol B. Surgical debridement C. Topical steroids only D. Oral steroids, azathioprine, metronidazole, or infliximab E. No treatment, will regress spontaneously Please visit http://www.eblueimages.org to answer these questions.