Bullous Pemphigoid Masquerading as Erythrodermic Psoriasis.

Bullous Pemphigoid occurs more commonly in the elderly with a rare occurrence in infancy, childhood and adolescence. The uniqueness of this presentation in the adolescents warrants this report. Both Erythrodermic Psoriasis and Bullous Pemphigoid are autoimmune skin disorders that differ in presentation though some of the symptoms may overlap. While Erythrodermic Psoriasis presents with massive scaling, Bullous Pemphigoid presents with vesiculo-bullous lesions and blisters which heal and keep spreading leaving burn-like areas. Bullous Pemphigoid is the most frequent subepidermal autoimmune bullous skin disease and could have a polymorphic presentation. At presentation there was massive scaling with intense itching however in the course of treatment, vesicles, blisters and bullae became apparent and the histology result was consistent with the diagnosis of Bullous Pemphigoid. Bullous Pemphigoid was therefore masquerading as Erythrodermic Psoriasis.

La pemphigoïde bulleuse se produit plus souvent chez les personnes âgées, mais rarement chez les nourrissons, les enfants et les adolescents. Le caractère unique de cette présentation chez l'adolescent justifie ce rapport. Le psoriasis érythrodermique et la pemphigoïde bulleuse sont des troubles cutanés auto-immuns dont la présentation diffère, bien que certains symptômes puissent se chevaucher. Alors que le psoriasis érythrodermique se manifeste par une desquamation massive, la pemphigoïde bulleuse présente des lésions vésiculo-bulleuses et des cloques qui guérissent et s'étendent en laissant des zones semblables à des brûlures. La pemphigoïde bulleuse est la maladie cutanée bulleuse auto-immune sous-épidermique la plus fréquente et peut avoir une présentation polymorphe. Au moment de la présentation, il y avait une desquamation massive avec des démangeaisons intenses, mais au cours du traitement, des vésicules, des cloques et des bulles sont apparues et le résultat de l'histologie était cohérent avec le diagnostic de la pemphigoïde bulleuse. La pemphigoïde bulleuse se faisait donc passer pour un psoriasis érythrodermique. Mots clés : Psoriasis érythrodermique, pemphigoïde, bulles, signe d'Auspitz.

A review of neonatal tetanus in University of Maiduguri Teaching Hospital, North-eastern Nigeria.

BACKGROUND: Neonatal tetanus is a vaccine preventable disease and is a leading cause of neonatal mortality in developing countries. The effectiveness of immunization and hygienic umbilical cord care practices in the prevention of the disease has been established. OBJECTIVE: The objective of this study was to audit the scourge of neonatal tetanus in a tertiary health facility in a resource-limited setting. MATERIALS AND METHODS: The study was a retrospective study. Case notes of neonates admitted with clinical diagnosis of tetanus into the Special Care Baby Unit (SCBU) between January 2009 and December 2010 were retrieved and evaluated to identify socio-demographic and clinical characteristics, mode of acquisition and severity of the disease, presence of co-morbidities, duration of hospital stay and outcome. RESULTS: Most of the mothers had no tetanus immunization (66.7%) and the main social class of the children was class V (45.1%) and IV (41.2%), respectively. Only 29.4% of the mothers attended ante-natal care (ANC) while majority of the patients were delivered at home (94.1%). Half of the neonates presented with the severe form of the disease (51.0%). Sepsis is a prominent co-morbidity (59.2%). Morality was high with case fatality of 66.7%. CONCLUSION: This high prevalence of neonatal tetanus with high mortality is not only disappointing but unacceptable in the 21(st) century. Therefore, all efforts must be re-focused on current preventive strategies while pursuing new areas such as slow-release mono-dose tetanus vaccine and school health programme as well as advocacy on political will for the sustainability of immunization programmes of women of child-bearing age.

Recurrent generalized tetanus: a case report.

We describe recurrent generalized tetanus in a four-year-old unimmunized boy following recurrent suppurative otitis media (SOM) within an 11-month period. There are not many published reports on recurrent tetanus. We highlight the importance of both primary immunizations and the need for active immunization before discharge as the infection does not confer a lifelong immunity. The usefulness of booster doses of tetanus toxoid and missed opportunities for immunization are emphasized.

Risk factors for an adverse outcome in bacterial meningitis in the tropics: a reappraisal with focus on the significance and risk of seizures.

The relationship of presentation to outcome in children with meningitis was analysed. The relative risk (95% confidence interval) of an adverse outcome (death or neurological sequelae) associated with presentation with at least three of ten features (age < or = 2 yrs, ill for > 7 days, antibiotic treatment, focal nerve deficits, abnormal posturing, abnormal muscle tone, lack of typical meningeal signs, shock, unrousable coma and seizures) was 4.9 (2.7, 8.8), p < 0.0001. The first six features were particularly associated with neurological sequelae, and shock and coma with death. Seizures were associated with either outcome. Two seizure types could be distinguished: seizures which occurred before or on diagnosis only (type I seizures) and seizures which occurred before and/or after diagnosis (type II seizures). Death occurred in 0/41 children without seizures and in 14/34 and 11/34 children with type I and type II seizures, respectively (p < 0.0001). Neurological sequelae occurred in 3/42 children without seizures and in 5/20 and 14/23 with type I and type II seizures, respectively (p < 0.0001).