title: Intractable localized pruritus as the sole manifestation of intramedullary tumor in a child: case report and review of the literature.
abstract: OBJECTIVE
  Persistent localized pruritus is a rare manifestation of central nervous system tumors. Delayed diagnosis can lead to devastating complications.
  
  
  METHODS
  We report an otherwise healthy 19-month-old girl who presented with signs of localized intractable pruritus of 6 months' duration on the left side of the neck, shoulder, and arm, resistant to systemic antihistamines and topical corticosteroids. Findings from skin biopsy, viral culture for varicella-zoster virus, and skin prick test to common food and animal allergens were nondiagnostic. Neurologic examination results were unremarkable. After several months of localized intractable pruritus, magnetic resonance imaging of the cervical spine with and without contrast was performed, which revealed an intramedullary spinal cord tumor extending from just above the foramen magnum to C6. The tumor was surgically resected and found to be a ganglioglioma. Within a week after the surgery her pruritus completely resolved.
  
  
  CONCLUSIONS
  We recommend a detailed neurologic examination in any case of persistent localized pruritus, in the absence of primary dermatologic causes. Given the challenges of performing a reliable neurologic examination in children, neuroimaging might be considered in children with intractable localized pruritus of unknown etiology of the head and neck or upper extremity, even in the absence of focal neurologic deficits.
authors.affiliation: Department of Dermatology, University of Utah, Salt Lake City, UT 84109, USA. razi.soltani@hsc.utah.edu
authors.forename: Razieh
authors.initials: R
authors.lastname: Soltani-Arabshahi
authors.forename: Sheryll
authors.initials: S
authors.lastname: Vanderhooft
authors.forename: C David
authors.initials: CD
authors.lastname: Hansen
mesh_terms: D002574:Cervical Vertebrae; D057210:Delayed Diagnosis; D003937:Diagnosis, Differential; D005260:Female; D005500:Follow-Up Studies; D018303:Ganglioglioma / Q000150:complications* / Q000175:diagnosis / Q000601:surgery; D006801:Humans; D007223:Infant; D008279:Magnetic Resonance Imaging; D019635:Neurosurgical Procedures; D011537:Pruritus / Q000175:diagnosis / Q000209:etiology*; D013120:Spinal Cord Neoplasms / Q000150:complications* / Q000175:diagnosis / Q000601:surgery