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AN UNUSAL CASE OF. CONDYLOMA ACUMINATA WITH MAGGOTS. BY. Prof. Renuka Mohanty Dr. S.Mahapatro Dr. S.S.Kar Dr. J.P.Mahapatra. HI-TECH MEDICAL COLLEGE & HOSPITAL, BHUBANESWAR. CASE HISTORY. 2 Yrs Male Child . Wt – 8 kg , SES - Poor C/C Difficulty in defecation since six months.

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AN UNUSAL CASE OF

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An unusal case of

AN UNUSAL CASE OF

CONDYLOMA ACUMINATA WITH MAGGOTS

BY

  • Prof. Renuka Mohanty

  • Dr. S.Mahapatro

  • Dr. S.S.Kar

  • Dr. J.P.Mahapatra

HI-TECH MEDICAL COLLEGE & HOSPITAL, BHUBANESWAR


An unusal case of

CASE HISTORY

  • 2 Yrs Male Child . Wt – 8 kg , SES - Poor

  • C/C

  • Difficulty in defecation since six months.

  • Passage of maggot since 15 days.

  • Mass over perianal region since last 6

  • months.


An unusal case of

HISTORY

He was treated with Homeopathic medicine, but in vain.

Antenatal , Natal and Postnatal history - Normal

Developmental History - Normal

No family history of such attack


An unusal case of

O/E

Wt – 08Kg , Ht – 80Cm.

Mild degree of anemia, HR – 100/m ,RR – 30 / m , BP – 80/60 mm Hg

CVS, P/A , Chest , CNS - Normal

LOCAL EXAMINATION OF PERIANAL AREA

  • Cauli flower like mass (5 x 4.5 x 2.5 cm3 )

  • Nonfriable , moist , fleshy , almost covering the anal

    opening.

  • Super infected with Maggots.

  • No bleeding from the mass.


An unusal case of

INVESTIGATIONS

Hb - 8 gm%

DC , TLC , URINE , STOOL - Normal

Blood for VDRL – Negative


An unusal case of

PATHOLOGY EXAMINATION (BIOPSY)

Consistent with Candyloma Acuminata

( Mucus membrane wart)

Acanthotic epidermis with pappillomatosis , hyperkeratosis & parakertosis. Dermal capillary vessels are thrombosed. There were koilocytes.


An unusal case of

TREATMENT :-

Initially treated with turpentine oil and IV antibiotics (Ampiclox)

After 5 days the whole mass was surgically removed.

FOLLOW UP :-

On 3m /6m /9m follow up there was no reoccurrence of the lesion


An unusal case of

DISCUSSION

  • Epidermal manifestation attributed to the

    epidermotropic HPV

  • HPV type 6 and 11 (90 % of CA)

  • HPV in genital area are mostly sexually

    transmitted.

    In paediatric age group > 3yr sexual abuse must be considered .

    In < 3 yr – by direct manual contact , indirectly by fomites or vertical transmission


An unusal case of

HPV

  • Common warts to squamous cell carcinoma

    of skin.

  • 70 subtypes are recognized.


An unusal case of

SITES

Perineum around the anus, vagina and urethra , intravaginal and intra-anal area ,glans penis, saft , corona , labia.

Rarely at conjunctive , gingiva and nasal mucosa , tounge , lip.


An unusal case of

  • May resolve spontaneously.

  • Salicylic acid

  • Podifilox 0.5% solution

  • Formaldehyde

  • Belomycin

  • Retinoids

  • Interferon α , β (Low effectiveness, high toxicity)

  • Cimetidine

  • Cry therapy

  • Laser therapy

  • Loop electro surgical excision


An unusal case of

  • Weekly application of 25% podophyllin on

  • tincture of benzoin.

  • Immiquimod (5% cream ) - Thrice Weekly

  • Resistance cases - Weekly freezing with

  • liquid nitrogen or by carbon dioxide lasar.


An unusal case of

With all forms of therapy – 50% reoccur.

So periodic follow up is required.


An unusal case of

THANK U


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