Peristomal struvite incrustations.

To cite: Resende CIP, Pereira T, Ribeiro J, et al. BMJ Case Rep Published online: [please include Day Month Year] doi:10.1136/ bcr-2014-207472 DESCRIPTION A 42-year-old woman who had a urostomy formed at the age of 6 years for a neurogenic bladder due to a myelomeningocele presented to our department with painful white deposits of hard consistency on peristomal skin, suggestive of struvite incrustations after some weeks of evolution (figure 1). The deposition of magnesium ammonium phosphate and carbonated apatite crystals (struvite) on peristomal skin occurs almost exclusively in urostomies, and is caused by contact with alkaline urine infected by urease-producing bacteria. 2 Our patient was treated with oral vitamin C and daily application of 2% salicylic acid gel/15% glycolic acid. She was observed 4 weeks later with good response (figure 2). The treatment of struvite incrustations on peristomal skin consists of oral rehydration with nonalkaline beverages, and acidification of urine with oral ascorbic acid and application of acidifying agents on peristomal skin. 2