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A Solitary Nodular Vulvar Lesion

Educational Objective
Based on this clinical scenario and the accompanying image, understand how to arrive at a correct diagnosis.
1 Credit CME

A girl in her teens presented with a unilateral itchy nodule on her right labium majus of 4 months’ duration. The patient was born and lived in a rural village in Malawi. Her medical and family history were unremarkable. She did not report fever or malaise. Physical examination revealed a polypoid, rubbery tumor measuring 1.5 cm located on her right labium majus, which obliterated the right labium minus (Figure, A). She did not present with enlarged lymph nodes, and results of the physical examination were otherwise unremarkable. An incisional lesional biopsy was taken (Figure, B and C).

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B. Late cutaneous bilharziasis

Histopathologic examination showed pseudoepitheliomatous epidermal hyperplasia and transepidermal elimination of basophilic oval-shaped structures. A dense acute and chronic inflammatory cell infiltrate composed of neutrophils, eosinophils, lymphocytes, and macrophages with granuloma formation was identified in the dermis. Numerous parasitic structures were observed in the granulomas (Figure, B and C). At high-power magnification, basophilic oval-shaped parasites with a terminal spine characteristic of Schistosoma haematobium were identified in the dermis (Figure, D).

Given these histopathologic findings, the diagnosis of late cutaneous bilharziasis (LCB) was made. However, the patient was lost to follow-up. Therefore, no additional tests could be performed to exclude complications (urine or fecal analyses, abdominal imaging), nor treatment given.

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Article Information

Corresponding Author: Xavier Cubiró, MD, Department of Dermatology, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Carrer de Sant Quintí, 89, 08026-Barcelona, Spain (xcubiro@santpau.cat).

Published Online: November 20, 2019. doi:10.1001/jamadermatol.2019.3446

Conflict of Interest Disclosures: None reported.

Additional Contributions: We thank the patient’s parents for granting permission to publish this information. We also thank Lluís Puig, MD, PhD, and Oriol Yélamos, MD, for their critical review. They received no compensation for their contributions.

References
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