A non‐healing perianal ulceration

Answer

This patient has a variation of haemangioma known as infantile haemangioma with minimal or arrested growth presenting as a non‐healing perianal ulceration. The diagnosis was confirmed by skin biopsy demonstrating strong diffuse positive GLUT1 immunostaining at the endothelial lining of the dermal vessels.^{1, 2} The arrested growth pattern explains the atypical appearance and the ulceration in the perianal area can possibly be explained by the fact that the early developing lesion is irritated by urine and faeces and traumatised by the necessary cleaning of the area. ^{3 , 4 , 5} The perianal ulceration showed a rapid response with complete healing within 4 months of propranolol initiation (Fig. 1b). The morphology and location posed a diagnostic dilemma and required multidisciplinary evaluation to exclude alternate pathologies, including infantile inflammatory bowel disease, immunodeficiency disorders, a large segmental haemangioma and LUMBAR syndrome. This case highlights the importance of including infantile haemangioma among the differential diagnoses in neonates presenting with rapid onset perianal ulceration.