This article presents a case history of white sponge nevus (WSN) in theperianal area of a 23-year-old Hispanic female. WSN is a rare, autosomaldominant disorder that affects the noncornified stratified squamousepithelia. Clinically, the lesions are characterized by the presence ofwhite, spongy plaques in the oral cavity. Extraoral lesions are found inother mucosal sites but are relatively uncommon in the absence of oralmanifestations. Because WSN is rare, the differential diagnosis of thislesion may be difficult and the diagnosis is best made by a tissue biopsyperformed in the context of a detailed patient and family history. Theproblems associated with differential diagnosis are addressed. Introduction Diagnosing lesions in the genital area by appearance can sometimes prove elusive as illustrated by the case of a 23-year-old Hispanic female who presented to an urban college health clinic with a long-standing complaint of a pruritic, white lesion in the anogenital area. Although the patient had numerous diagnoses and treatments over a five year period, the lesion remained unchanged. Case Report Subjective Data The patient is a 23-year-old Hispanic female who presents to a college health clinic for the diagnosis and management of a “white, itchy spot” in her genital area. In the past five years, she states that she has been evaluated, diagnosed, and treated for the same condition at several other clinics and private practices. She was previously diagnosed and treated for a yeast infection and anal warts, for this same complaint, with no resolution of symptoms. She has looked up these conditions, for which she was treated, on the internet and does not feel that she was appropriately diagnosed. Past Medical History The patient’s general health is reportedly good. The patient was successfully treated for chlamydia in 1994 and has had no other sexually transmitted diseases. She started menstruating at age 12 and became sexually active in her late teens. She has been taking oral contraceptive pills (OCPs) intermittently for the past 5 years when sexually active. She reports a monogamous relationship at present. She infrequently uses condoms for contraception and would like to start on OCPs again. She does not smoke and denies use of alcohol. She states that her mother (aged 48 years) is currently being treated for an aggressive cervical cancer, a fact that makes her more anxious about her condition. She denies that any other immediate family members have a similar condition or that she has any similar lesions elsewhere on her body. Objective Data In a lithotomy position, the lesion is easily visible. The patient has a 3-4 cm diameter lesion around her anus. The lesion is a white, lichenified, well-defined plague with a ruggated or corrugated surface (See figures1 and 2). A small amount of scar tissue is visible around a partial perimeter of the lesion, which could be a result of past treatment for anogenital warts. There are no other lesions in the genital area on both internal and external exam. There are no other lesions that extend into the anal canal or the vaginal vault. The physical and pelvic exam are completely within normal limits. There are no nail or skin abnormalities and no lymphadenopathy. The oral cavity is clean and the teeth are in good condition. No lesions are noted in the nose or throat. The Pap smear obtained shows inflammation for the second time in 15 months.
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