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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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Presentation Transcript
slide1

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

slide2

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.
slide3

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

slide4

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.
slide6

INVESTIGATIONS

Hb - 8 gm%

DC , TLC , URINE , STOOL - Normal

Blood for VDRL – Negative

slide7

PATHOLOGY EXAMINATION (BIOPSY)

Consistent with Candyloma Acuminata

( Mucus membrane wart)

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

slide8

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

slide9

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

slide10

HPV

  • Common warts to squamous cell carcinoma

of skin.

  • 70 subtypes are recognized.
slide11

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.

slide12

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
slide13

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.
slide14

With all forms of therapy – 50% reoccur.

So periodic follow up is required.

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