Infantile hemangioma masquerading as persistent diaper dermatitis in the setting of LUMBAR syndrome with a congenital cutaneous skeletal muscle hamartoma.

Abstract

Diagnostic consideration and identification of infantile hemangiomas (IHs) are critical to prevent complications and determine the potential for extracutaneous comorbidities that require early intervention. We present a patient referred to dermatology for persistent diaper dermatitis then discovered to have an extensive segmental lumbosacral, sacrococcygeal, and pelvic IH complicated by gluteal ulceration that improved with initiation of propranolol and constellation of findings consistent with LUMBAR syndrome prompting additional multisystem evaluation. The patient also presented with a paramedian caudal appendage where excisional histopathology revealed a complex cutaneous hamartoma with mature skeletal muscle differentiation consistent with a rhabdomyomatous mesenchymal hamartoma. This case highlights the essential consideration of anogenital IHs in the differential of refractory diaper dermatitis requiring prompt dermatology evaluation.