Abstract
<h3>REPORT OF A CASE</h3> A 5-year-old boy was referred to The Johns Hopkins Dermatology Service, Baltimore, because of a perianal skin lesion. Nonpruritic scrotal erythema was first noted five months before this clinic visit, and the appearance of swelling of the penis was reported one week following the erythema. These symptoms were only partially relieved by topical tolnaftate cream, oral diphenhydramine hydrochloride, and cool compresses. The patient's medical history was remarkable for removal of a juvenile xanthogranuloma at age 16 months with no further recurrence. Seven months before the present consultation, the patient was seen by a gastroenterologist for intermittent constipation. The perianal lesions were not present at that time. The patient had no history of significant diarrhea, fever, alteration in rate of growth, or arthralgias. Physical examination revealed a healthy-appearing child in no acute distress. His height of 102.3 cm and weight of 15.1 kg were both just below
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