No abstract

INTRODUCTION: Women are at the highest risk for developing a substance use disorder during their reproductive years. The prevalence of marijuana use in the US during pregnancy is 7%. Data is unclear regarding long-term effects of in-utero marijuana exposure. Given that the endocannabinoid system is present at around day 16 of gestation, it is plausible that maternal marijuana use could affect fetal brain development. This purpose of this study was to determine correlations between in-utero marijuana exposure and childhood developmental delay. METHODS: After IRB approval, a retrospective chart review of infants with a history of marijuana exposure in utero was conducted. A total of 230 study subjects met inclusion criteria and were analyzed. RESULTS: The majority of subjects, 84 (59.6%) were noted to have feeding problems in infancy. Forty one subjects, 17.8% showed abnormal muscle tone, 39 subjects, 17%, were noted to be small for gestational age (SGA). Speech delay was present with a frequency of 10.0%, 23 subjects. Fine motor delay was seen in 25 subjects, 10.9% and global development delay with noted in 21 subjects, 9.1%. CONCLUSION: Results from this retrospective chart review indicate possible risks of short-term (feeding problems, abnormal muscle tone, SGA) and longer-term developmental delays. Further research is necessary to determine whether these effects are due to marijuana alone, or if confounding factors are involved. In order to educate and advise the public about the effects of marijuana use in pregnancy, this relationship must first be understood.

Check for updatesperistomal rash for many years. The patient reported the rash had been present for at least 5 years and was getting larger. It was described as pruritic and tender. The rash was initially attributed to urine leakage and had been treated as eczema, a fungal infection, and with wound and stoma care unsuccessfully for years before presentation. Patient had been using wound cleanser spray, normal saline, nystatin powder, and miconazole. The dermatologic exam revealed a large erythematous plaque with areas of maceration around the stoma involving most of the right abdomen extending to the pubis (Figure 1a and Figure 1b). A shave biopsy was performed from around the peristomal lesion for histopathologic diagnosis. The biopsy showed infiltration of the epidermis with large, atypical epithelioid cells with enlarged hyperchromatic nuclei and pale cytoplasm in solitary units and nests (Figure 2a and Figure 2b). These cells showed diffuse and strong expression of CK7 (Figure 2c) and GATA 3 (Figure 2d), and focal expression of CK20, CDX2, and BerEp4. The cells were negative for P63, CEA, Sox10, PSA, and TTF-1. No intracytoplasmic mucin was seen on mucicarmine stain and periodic acid-schiff stain was negative for fungal organisms. The morphologic and immunohistochemical features are consistent with secondary extramammary Paget Disease, consistent with involvement by the patient's known urothelial carcinoma of the bladder.

Extramammary Paget disease (EMPD) is a rare, cutaneous condition, which can present secondary to underlying carcinoma as an eczematoid rash that often mimics other conditions. Secondary EMPD should, therefore, be considered in the differential diagnosis where there is potential for malignant extension, particularly in post-operative tissue. This report describes a case of secondary EMPD of the peristomal skin in a patient with a distant history of cystectomy with ileal conduit for urothelial carcinoma, who developed an extensive eczematoid rash over 5 years after attempting several ineffective treatments. Early dermatologic referral for persistent inflammatory cutaneous disorders and appropriate histopathologic testing may reduce delays in the diagnosis of EMPD.