Pellagra secondary to selective eating in a child with autism.

Once a significant cause of morbidity and mortality, health care providers rarely see primary pellagra in developed countries where fortification of foods with niacin is commonplace and niacin-rich foods are generally widely available. We report a ten-year-old boy with autism spectrum disorder who presented with photosensitive dermatitis which resolved after vitamin supplementation and dietary changes. In this child, the pellagra developed as the result of a long-term pattern of selective eating. Restricted diets, even to the point of nutrient deficiencies, are well-documented among children with autism spectrum disorders (ASD).

Evolution of Fibroblastic Connective Tissue Nevus in an Infant.

Fibroblastic connective tissue nevus (FCTN) is a rare and recently described neoplasm of fibroblastic/myofibroblastic lineage. We report a case of a 1-month-old healthy male infant who presented with a dermal plaque on the upper chest since birth. A punch biopsy demonstrated a dermal spindle-cell neoplasm with variable smooth muscle actin positivity and negative staining for CD34, consistent with myofibroma. Over the course of the next year, the remaining lesional tissue exhibited clinical softening and a surgical excisional specimen revealed histologic findings distinct from the original biopsy. These included a poorly circumscribed proliferation of bland spindle cells arranged in short fascicles centered in the dermis and extending into the subcutis with positivity for CD34, and absence of staining with smooth muscle actin features diagnostic of FCTN. Our case allowed the opportunity to see this unusual neoplasm at different stages, and we hypothesize that FCTN may undergo an early cellular phase and that time is required for these lesions to "mature" and demonstrate the more characteristic features of FCTN.

Umbilical Granuloma in a 2-Month-Old Patient: Histopathology of a Common Clinical Entity.

Umbilical granulomas are the most common anomaly of the umbilicus in neonates and infants. These lesions are characterized by an overgrowth of granulation tissue that persists at the base of the umbilical cord after its separation. Histologically, they consist of granulation tissue, which is composed of fibroblasts, inflammatory cells, and vascular endothelial cells set in an edematous stroma. Although umbilical granulomas are commonly seen clinically, there are no reports of their histopathology in the literature. The authors present the histology of this clinical finding in a 2-month-old infant, as it is important for the pathologist to be aware of this benign entity and distinguish it from other umbilical anomalies that may be of greater clinical significance.