ABSTRACT
Objectives: To describe a case of Crohn's disease presenting as an anal ulceration in a 12 year-old girl, diagnosed initially as sexual abuse. Description: We study a case of Crohn?s disease presenting as a perianal ulcer in a 12 year-old girl, diagnosed initially as sexual abuse with serious medico-legal, psychological and socio-familiar implications. Comments: Crohn?s disease is rare during childhood, and a minority presents as perianal ulcers. Considering sexual abuse against adolescents is much commoner it turns essential to consider the differential diagnosis correctly, because of the risks involved, mainly represented by psychological and familiar disruption, medico-legal implications and treatment delay.
Subject(s)
Humans , Female , Adolescent , Crohn Disease/diagnosis , Crohn Disease/therapy , Child Abuse, SexualABSTRACT
T-cell leukemia/lymphoma (T-c LL) associated with prior infection with HTLV-I is rarely described in children. We present herein, the clinical, morphological, and virologic features of T-c LL, which occurred in eight pediatric cases with similar features of ATLL described in adults. There were three girls and five boys with age ranging from 2 to 18 years. Lymphoadenopathy, hepatosplenomegaly and marked skin lesions were presented in all cases. Five patients had hypercalcemia. The diagnostic criteria of T-c LL were based on both morphological and immunophenotypical analyses characterized by T-cell markers positively. Seven cases were cCD3+, CD4/CD25+, whereas CD1a and TdT were negative in all cases tested. HTLV-I antibodies were detected in all cases. HTLV-I provirus integration of at least one provirus was seen in all cases tested by molecular analysis. Mother-to-child transmission of HTLV-I was demonstrated in six cases. Interestingly, a homozygous deletion in p16 gene locus was observed in all four cases studied, while exons 7 and 8 of p53 were deleted in one child. The deletion of the p16(INK4A)/p14(ARF) or mutation of p53, key regulatory protein of cell cycle checkpoint in G1/S progression, found in five of the eight pediatric patients suggests that in these cases genetic lesions associated with HTLV-I infection may predispose for an early onset of leukemia.
