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Urethral meatal stenosis in junctional epidermolysis bullosa: a rare complication effectively treated with a novel and simple modality.
[junctional epidermolysis bullosa]
A
10
-
year
-old
boy
was
diagnosed
with
non-
Herlitz
junctional
epidermolysis
bullosa
(
nh-
JEB
)
shortly
after
birth
when
he
developed
blisters
on
his
feet
and
under
the
toenails
.
His
younger
brother
was
also
affected
by
nh-
JEB
.
Their
parents
were
first
cousins
.
Immunofluorescence
mapping
showed
a
blister
in
the
lamina
lucida
and
reduced
staining
with
GB
3
antibody
against
laminin
V
.
Molecular
analysis
showed
a
homozygous
mutation
in
the
LAMC
2
gene
.
The
patient
complained
of
intermittent
inability
to
pass
urine
,
causing
significant
suprapubic
pain
,
anxiety
,
and
general
discomfort
.
He
reported
the
development
of
blisters
and
erosions
at
the
urethral
meatus
,
which
caused
fusion
of
the
meatal
opening
.
In
order
to
micturate
,
he
had
to
tear
apart
the
fused
tissue
,
resulting
in
considerable
pain
.
Physical
examination
revealed
multiple
healing
erosions
and
atrophic
scars
,
mainly
on
the
legs
(
Fig
.
1
)
,
and
anonychia
of
most
of
the
toenails
.
The
walls
of
the
urethral
meatus
were
adherent
(
Fig
.
2
)
.
The
urethral
meatus
could
not
be
opened
using
a
moderate
amount
of
pressure
by
the
examining
physicians
.
Prevention
of
re
-stenosis
of
the
urethral
meatus
was
accomplished
with
the
application
of
Mepilex
(
Mölnlycke
,
Sweden
)
to
the
urethral
meatus
after
each
micturition
,
where
it
remained
until
the
next
episode
of
micturition
.
Since
the
institution
of
this
care
regimen
10
months
ago
,
there
has
been
no
recurrence
of
the
stenosis
.
Diseases
Validation
Diseases presenting
"pain"
symptom
achondroplasia
acute rheumatic fever
adrenal incidentaloma
adrenomyeloneuropathy
aniridia
aromatase deficiency
carcinoma of the gallbladder
cholangiocarcinoma
coats disease
congenital diaphragmatic hernia
congenital toxoplasmosis
cushing syndrome
cutaneous mastocytosis
cystinuria
dedifferentiated liposarcoma
dentin dysplasia
dracunculiasis
dystrophic epidermolysis bullosa
epidermolysis bullosa simplex
erdheim-chester disease
erythropoietic protoporphyria
esophageal adenocarcinoma
esophageal carcinoma
esophageal squamous cell carcinoma
fabry disease
familial mediterranean fever
focal myositis
hirschsprung disease
hodgkin lymphoma, classical
holt-oram syndrome
junctional epidermolysis bullosa
kabuki syndrome
kindler syndrome
lamellar ichthyosis
liposarcoma
locked-in syndrome
lymphangioleiomyomatosis
malignant atrophic papulosis
neuralgic amyotrophy
oligodontia
oral submucous fibrosis
papillon-lefèvre syndrome
phenylketonuria
pleomorphic liposarcoma
primary hyperoxaluria type 1
proteus syndrome
pyomyositis
scrub typhus
sneddon syndrome
systemic capillary leak syndrome
thoracic outlet syndrome
trochlear dysplasia
typhoid
von hippel-lindau disease
waldenström macroglobulinemia
well-differentiated liposarcoma
wolf-hirschhorn syndrome
This symptom has already been validated