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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
"anxiety"
symptom
22q11.2 deletion syndrome
achondroplasia
adrenal incidentaloma
adrenomyeloneuropathy
cadasil
child syndrome
classical phenylketonuria
cohen syndrome
congenital adrenal hyperplasia
congenital toxoplasmosis
cutaneous mastocytosis
fabry disease
familial hypocalciuric hypercalcemia
familial mediterranean fever
gm1 gangliosidosis
hereditary cerebral hemorrhage with amyloidosis
junctional epidermolysis bullosa
locked-in syndrome
monosomy 21
oligodontia
oral submucous fibrosis
phenylketonuria
von hippel-lindau disease
x-linked adrenoleukodystrophy
This symptom has already been validated