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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. 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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  1. 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

  2. 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.

  3. 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

  4. 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.

  5. INVESTIGATIONS Hb - 8 gm% DC , TLC , URINE , STOOL - Normal Blood for VDRL – Negative

  6. PATHOLOGY EXAMINATION (BIOPSY) Consistent with Candyloma Acuminata ( Mucus membrane wart) Acanthotic epidermis with pappillomatosis , hyperkeratosis & parakertosis. Dermal capillary vessels are thrombosed. There were koilocytes.

  7. 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

  8. 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

  9. HPV • Common warts to squamous cell carcinoma of skin. • 70 subtypes are recognized.

  10. 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.

  11. 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

  12. 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.

  13. With all forms of therapy – 50% reoccur. So periodic follow up is required.

  14. THANK U

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