Mucocolpos in a toddler: central precocious puberty with vaginal atresia.

OBJECTIVE: To report the first case of imperforate hymen and vaginal atresia in a patient with mucocolpos during toddlerhood who was found to have central precocious puberty.

METHODS: We review the details of assessment of an 18-month-old girl who had the presence of pubic hair and breast enlargement. She underwent biochemical evaluation with serum follicle-stimulating hormone, luteinizing hormone, and estradiol and radiologic evaluation with ultrasonography of the abdomen and pelvis as well as magnetic resonance imaging of the pelvis and brain.

RESULTS: This young female patient had clinical and imaging findings suggestive of idiopathic central precocious puberty. Imaging also revealed imperforate hymen, vaginal atresia, and mucocolpos. She underwent surgical treatment to ensure an unobstructed vaginal opening before initiation of gonadotropin-releasing hormone agonist therapy, since the latter may precipitate uterine bleeding and might have converted mucocolpos to a combination of mucocolpos and hematocolpos.

CONCLUSION: This case highlights the need to suspect the presence of precocious puberty in all female patients in whom mucocolpos is detected beyond infancy but before adolescence.