Page 26 - SPD Review Winter 2014

Literature Review - Winter 2014

for food allergy in 33 patients (36%). Of these, 8 of 16 patients who had food  SURGERY

challenges had positive results and 4 of these patients had remission of CU

with speciic food elimination. At 1 year of follow-up, 18.5% of patients were in Gibrell WO, Selcen D, Zeidan MM, Ishitani MB, Moir CR, and Zarroug AE.

remission, but 68% of patients were in remission at 5 years. The authors could
Safety and yield of muscle biopsy in pediatric patients in the modern era. J

not identify any speciic factors that predicted remission.
Pediatr Surg. 2014;49:1429-1432.

(Submitted by Carrie C. Coughlin)

The authors conducted a retrospective study of pediatric patients who under-

Archer SR, Abramowsky CR, Kobrynski L, et al. Malakoplakia and primary went muscle biopsy at the Mayo Clinic (Rochester, Minnesota) from 2008-2012

immunodeiciency. J Pediatr. 2014;165(5):1053-1056.
to assess diagnostic yield and clinical utility. All 169 specimens contained ad-

equate tissue for pathologic evaluation, and concomitant skin biopsy from the

Malakoplakia is a rare granulomatous disease caused by impaired macrophage incision edge was obtained in 71 patients. In 60% of the cases, a pathologic

response and is found commonly in the urinary tract of immunocompetent indi- diagnosis was made. The only complication was a right femoral vein lacera-

viduals. Worldwide, less than 500 cases have been documented with only 13 in
tion when the right vastus medialis muscle was chosen as a biopsy site. The

the pediatric population, 8 of which were immunocompetent children while the authors disagree with most of the reported literature about the diagnostic yield

others were not. Malakoplakia presents with umbilicated yellow papules and of muscle biopsy. These previous studies reported limited usefulness of muscle

plaques of varying sizes and can extend from the mucosa to underlying muscle
biopsy, but the authors consider the results of a muscle biopsy to contribute
and fascia. The disease has a mortality rate of 50%. The authors reported 3 pe-
substantially to disease management for the patient. Even if a deinitive patho-

diatric patients with the disease in locations outside of the genitourinary tract logic or clinical diagnosis is not made, the suggestion and/or exclusion of other

with known primary immunodeiciencies (X-linked agammaglobulinemia, com-
possibilities is likely. Limitations to this study include the design as a retrospec-
mon variable immune deiciency, and severe combined immunodeiciency).
tive study, with the associated patient-selection bias. Additionally, the Mayo

One case involved the gluteal muscle, another a cervical lymph node, and a Clinic is a tertiary referral center with a dedicated muscle laboratory and pedi-

inal with rectosigmoid involvement. This case highlights that malakoplakia can
atric anesthesiologists. (Submitted by Kate Marks, DO)
present in children and reminds us to consider this in the differential diagno-

sis in patients with immunodeiciencies with chronic, fungating or ulcerating

wounds given its high mortality rate. (Submitted by Maria Elena Miyar, MD)

26 SOCIETY FOR PEDIATRIC DERMATOLOGY  www.pedsderm.net