engleski

An unfortunate case of perianal lichen simplex chronicus

Introduction: Anal pruritus may be a sign of a variety of diseases, including inflammation, infections, and cancer. Case report: A 78-old patient initially presented to our Clinic in November 2015 due to itching of the perianal area present for several years. On examination, there was lichenification of the whole perianal area with slightly verrucous papules. Histological analysis of a biopsy specimen was consistent with a diagnosis of Lichen simplex chronicus and Prurigo nodularis, while PCR was negative for HPV (high risk and low risk). According to regular follow up visits during the period from 2015 to 2018, the patient was treated symptomatically with topical corticosteroid creams and systemic H1 antihistamines, resulting in a temporary regression of the skin lesions and subjective reduction in pruritus. In 2017, there was significant worsening with reoccurrence of verrucous papules along with fissures, and a second biopsy was performed. Histological analysis again confirmed Lichen simplex chronicus and symptomatic treatment provided partial remission. During the period from 2019 to 2021, the patient did not present for follow up to our Clinic. However, at the beginning of 2021, an incision and drainage of a perianal abscess was performed at the department of Digestive surgery, with re-incision at the end of May 2021 due to continuous purulent secretion. He presented to our Clinic again at the beginning of 2022, when there was a firm, nodular, perianal infiltrate of approximately 3 cm in diameter at the left perianal region. Histological analysis of a biopsy specimen showed dermal infiltrate of mucinous carcinoma, and the subsequent colonoscopy showed a 10 cm long stenosing rectal tumor with biopsy confirming villous adenoma with adenocarcinoma. The patient was further treated with radical surgery and is planned for further treatment with adjuvant chemotherapy. Conclusion: Persistent anal pruritus is usually due to benign, non-life- threatening conditions. However, anal pruritus of long duration, especially in elderly patients, can be a sign of malignant anorectal pathology, warranting cautious approach and detailed workup including proctosigmoidoscopy or colonoscopy.

Lichen simplex ; Pruritus ; Mucinous Adenocarcinoma ; Colorectal Carcinoma

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