UPMC Dermatopathology "Case of the Month" Presentations
UPP - Department of Dermatology, Dermatopathology Unit
Case Authors: Robin P. Gehris, MD, Douglas S. Kress, MD, Suzan Obagi, MD, Drazen Jukic, MD, PhD
OCTOBER 2004 CASE OF THE MONTH
CLINICAL FINDINGS
CLINICAL HISTORY:A 6 year-old otherwise healthy white female presented to the cosmetic surgery office for the treatment of several blue-red lesions on her thighs. These had initially emerged near the end of her first year of life and had been attributed by her mother to the localized trauma from her childhood immunizations; however she had recently begun to develop new lesions on her back and sides. The lesions were felt clinically to be vascular in origin, so a series of pulsed dye laser treatments were administered with minimal improvement. She was subsequently biopsied for confirmation of the diagnosis.
The initial biopsy, which was performed on a lesion on her back, failed to reveal any vascular pathology, but instead showed a mast cell-rich dermatosis that was felt to correlate poorly with the clinical picture. She was thus referred to pediatric dermatology for further workup and diagnosis.
Her father accompanied her to her consultation visit and reported a history of similar blue-colored, asymptomatic lesions on his own back and extremities since childhood. His past medical history was significant for recurrent boughts of sharp abdominal pain for which he had received a CT scan and an abdominal ultrasound. He was told by his primary care physician that he had diverticulitis and a “bump” on his kidney for which no further workup had been recommended.
Based on the similar clinical appearance
of the lesions in the patient and her father, the family requested that a biopsy
be performed on the father.
Physical Examination:
On physical examination,
the child had several soft and easily-compressible blue-red nodules on her bilateral
anterior thighs, side and upper back. None of these were painful; none produced
visible sweat with lateral stroking. [see: FIGURE 1 and FIGURE 2 ]
Her father also had multiple bluish-hued, easily-compressible lesions on his
trunk and extremities.[ see: FIGURE 3 and FIGURE 4 ]
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