Perianal Abscess With Stellate Lacerations in a 3.5-year-old Previously Healthy Boy
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lymphoproliferative disease: twenty-five years after the discovery. Pediatr Res. 1995;38:471-8. 4. Booth C, Gilmour KC, Veys P, et al. X-linked lymphoproliferative disease due to SAP/SH2D1A deficiency: A multicenter study on the manifestations, management, and outcome of the disease. Blood. 2011;117:53-62. 5. Marsh RA, Bleesing JJ, Chandrakasan S, et al. Reduced intensity conditioning hematopoietic cell transplantation is an effective treatment for patients with SLAM-associated protein deficiency/X-linked lymphoproliferative disease type 1. Biol Blood Marrow Transplant. 2014;20:1641-5.
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Perianal Abscess With Stellate Lacerations in a 3.5-year-old Previously Healthy Boy
laceration of the anus leading to stool incontinence. His physical examination was otherwise unremarkable. A rectal examination revealed painful inflammation purulent discharge and stellate lacerations of the anal mucosa and skin (Fig. 1a).
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erianal abscesses are soft tissue infections of the perianal region and are common in infants [1-3]. Most of them are idiopathic, although there may be an association with congenital abnormalities of the crypts of Morgagni or an infection of the cryptoglobular glands [1-3]. They occur mainly in males, which may be due to androgen excess in cases of androgen-estrogen imbalance or to abnormal development of androgen-sensitive glands in utero [1]. In older children, the etiology shifts to underlying diseases, such as inflammatory bowel disease, immune deficiency syndromes, trauma, infected mass lesions and other immunodeficiencies [4]. The most common organisms isolated are mixed aerobic and anaerobic bacteria from gastrointestinal tract flora [5]. The appropriate management of perianal abscess is incision, drainage and antimicrobial treatment [3]. A 3.5-year-old boy presented with a three day history of pain, skin irritation and discharge of pus around the anus. Notably, fifteen days prior to admission, he developed an upper respiratory tract infection treated with oral second-generation cephalosprin. Five days later, while on antimicrobial treatment, he complained of pain during defecation and his mother noticed mild redness around the anus. The patient was afebrile. Laboratory investigations revealed severe neutropenia (absolute neutrophil count: 0.14×109/L). The patient was treated with topical corticosteroids, but showed no improvement. The child continued to complain of perianal pain and the inflammation worsened with purulent discharge. Three days prior to admission, he received oral metronidazole, without improvement. Past medical history was unremarkable, and there was no history of constipation before or during the preceding vir
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