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Child Abuse Case 18

An 18-month-old toddler presents with perianal itching and a history of bumps on her perianal area for the past 2 months. Her mother states that these bumps have increased in number. The toddler is developmentally appropriate, lives at home with her mother and father and a 6-year-old brother. She has not had any changes in behavior, sleeps and eats well and has been cared for by her mother and father, with a babysitter on rare occasions on weekends. She has not been potty trained and she is not having any genitourinary symptoms other than pruritis. Her mother had an abnormal Pap smear just prior to the child’s birth. Neither the child nor other family members have any hand warts. Her physical examination is normal other than the findings demonstrated in the photograph below.

Case 18

Based on this history, the most likely etiology is:

  1. Human papillomavirus due to perinatal transmission.
  2. Condyloma lata due to secondary syphilis.
  3. Multiple molluscum contagiosum due to autoinnoculation.
  4. Irritation from pinworms due to fecal-oral transmission.

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