[Perianal papules in a child].

The patient was a 10-year-old boy with no past history of interest, who was seen for a 2½-month history of perianal lesions and daily diurnal and nocturnal encopresis. After the condition developed, the child had become more withdrawn. The lesions had been seen previously in another center, being diagnosed as viral warts. The abdomen was slightly distended, soft, nontender, and dull to percussion, and feces were palpable in the colon throughout its length. The tone of the anal sphincter was reduced and the rectum was full of soft feces. In the perianal region there were 5 or 6 extremely macerated, hemispheric, skin-colored papules of about 4 mm in diameter, some of which were pediculated (Figure 1). Additional Tests Complete blood count and coagulation studies were normal. Colonoscopy demonstrated the presence of soft green feces in the rectum and sigma and an increase in the diameter of the colon throughout its length. The mucosa had a normal appearance, color, and vascularization. Histopathology The epidermis was hyperplastic, with hypergranulosis and compact orthokeratotic hyperkeratosis, and there was a lymphocytic infiltrate in the dermis (Figure 2). Studies using the polymerase chain reaction (PCR) did not identify any subtypes of the human papillomavirus (HPV). Documento descargado de http://www.actasdermo.org el 10/04/2017. Copia para uso personal, se prohíbe la transmisión de este documento por cualquier medio o formato.