Internal Medicine

0521779407-17 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 21:19

1256 Purine and Pyrimidine Disorders Pyogenic Granuloma

■APRT deficiency: good prognosis if detected early and treatment

started

■ASL deficiency: may be mild or have more severe neurologic disease,

prognosis generally poor

■XDH deficiency: renal failure may occur

■ADA/PNP deficiencies: death in childhood from infection if not

treated, bone marrow transplant may be curative, but some series

report high mortality (grave prognosis in general for PNP def. – no

patient survived to 3rd decade). ADA deficiency was the first inher-

ited condition to be treated with gene therapy (long-term prognosis

under study).

■UMPS, UMPH1 deficiencies: good prognosis in treated patients

■DHPD, DHPA deficiencies: variable prognosis ranging from asymp-

tomatic individuals to severe neurologic illness

PYOGENIC GRANULOMA

JASON HUBERT, MD

REVISED BY JEFFREY P. CALLEN, MD

history & physical

■May be related to minor trauma

■Present as red or pink pedunculated papules or nodules

■Common sites are the lips, periungual skin, and face

■Frequently arise on the gums and lips in pregnant women

■May have a history of profuse bleeding from the lesion

tests

■Skin biopsy usually diagnostic

differential diagnosis

■Includes Kaposi’s sarcoma, bacillary angiomatosis, and nodular

amelanotic melanoma

management

■Dependent on size and location of the lesion

■Curettage and electrodesiccation often sufficient

specific therapy

■Other options include carbon dioxide laser, cryotherapy, and surgical

excision.