Asia Pacific Journal of Pediatric and Child Health

Abstract Ref Number = APCP879

Poster Presentation

Juvenile polyposis syndrome of the colon with concomitant Blastocyctis Hominis infection and its skin manifestation

Melati Arum Satiti,Fatima Safira Alatas,Muzal Kadim RSUPN Cipto Mangunkusumo

Background : Incidence of juvenile polyposis syndrome (JPS) is 1 in 100,000–160,000 population. Clinical manifestation may include recurrent or prolonged diarrhea followed by hematoschezia, and rectal prolapse. This condition may cause susceptibility to infection including parasite such as Blastocystis Hominis (BH). Objective: To describe a case of JPS of the colon with concomitant BH infection. Case Presentation Summary : Objective: To describe a case of JPS of the colon with concomitant BH infection. Case: A 9 years old girl with prolonged bloody diarrhea for 1 year prior to hospital admission (PHA). There was history of recurrent rectal prolapse and severe anemia with hemoglobin (Hb) 4 g/dL. She underwent colon resection due to incarcerated rectal prolapse around 6 months PHA. The entire colon looked reddish and full of lumps. Diarrhea still occurred after the operation and the patient started to lose weight. Overtime, patient developed reddish scaly rash all over the body which was itchy. There were also swollen face and lower extremities. Blood examination showed anemia Hb (10.8 g/dL), hypoalbuminemia (1.47 g/dL) and eosinophilia (16%) with hyper IgE 970.7. Skin biopsy showed early sign of psoriatic lesion. Fecal ELISA examination showed high –1 antitrypsin (56.91 mg/dL) dan calprotectin (1,585.59 mg/dL). Colonoscopy showed multiple polyps of the entire colon. Polyp biopsy showed benign juvenile polyp, while mucosal biopsy showed increased amount of polymorphonuclear, lymphocyte, plasma cell and eosinophil (32–34 per wide field view). Fecal parasitic evaluation showed BH infection, which could not be cured by metronidazole. Despite regular polypectomy every 2-3 weeks, patient was treated with Paromomycin for 21 days, which showed good response againts BH. Skin condition and diarrhea resolved along with decreasing number of polyps, and patient started to gain weight. Learning Points/Discussion : Conclusion: Juvenile polyposis syndrome may cause severe clinical manifestation when it is not detected early and not treated aggressively.

Keywords: Juvenile polyposis syndrome Colon polyp Blastocyctis Hominis Bloody diarrhea