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Summary: GAPO syndrome associated with pyoderma vegetans: an unreported co-existence: GAPO syndrome is a rare autosomal recessive disease and an acronym composed of growth retardation, alopecia, pseudoanodontia, optic atrophy. Approximately 38 cases have been reported in literature until now. Pyoderma vegetans is a chronic inflammatory disease characterized with vesicopustular, exudative and vegetative lesions usually localized on face, scalp, axilla and genitalia. Pyoderma vegetans is attributed to a bacterial infection frequently occurring in individuals with an underlying immunosuppressive condition. A 30-year-old female patient was admitted to our clinic with complaint of a hemorrhagic, crusted, exudative vegetative two plaques on the scalp. On her physical examination, she had a prematurely aged face, predominant lower lips, total tooth loss, frontal bossing, enlarged anterior fontanelle, marked scalp veins, micrognatia, depressed nasal bridge, short stature, growth retardation. She was diagnosed as GAPO syndrome as the result of her physical examination. Result of the biopsy taken from scalp was evaluated as pyoderma vegetans. And the diagnosis of pyoderma vegetans was established based on the correlate of both clinical and histopathologic findings. Pyoderma vegetans coexisting with GAPO syndrome has not been reported previously. Thus we wished to report it.
Key-words: GAPO Syndrome - Pyoderma vegetans - Growth retardation - Alopecia - Optic atrophy - Pseudoanodontia.
INTRODUCTION
GAPO syndrome is a quite rare genetic disease. GAPO is the acronymic designation for a complex of growth retardation, alopecia, pseudoanodontia (failure of tooth eruption) and progressive optic atrophy. It seems to have an autosomal recessive pattern of inheritance (3, 7). The etiology of disease is not yet well understood although Wajntal et al. suggested that there is a lack of breakdown of extracellular components, perhaps due to deficiency of an enzyme involved in the metabolism of extracellular matrix (10).
Pyoderma vegetans is a chronic inflammatory disease characterized with vesiculopustular, exudative and vegetative lesions usually localized on face, scalp, axilla and the genitalia. Although cases associated with ulcerative colitis, diffuse T-cell lymphoma, alcoholism, chronic malnutrition, HIV infection and chronic myeloid leukemia have been reported in literature, it may rarely be seen in healthy individuals (1,5). Coexistence of GAPO syndrome and pyoderma vegetans has not been reported previously.
Here we report a 30-year-old female case with the novel findings of severe bilateral interstitial keratitis and...