[Non-tuberculous mycobacterial cervical adenitis in children: 2 cases]. / Deux cas d'adénite cervicale à mycobactéries non tuberculeuses chez l'enfant.

BACKGROUND: Cervical lymphadenitis is the most common manifestation of infection with nontuberculous mycobacteria (NTM) in immunocompetent children. Nevertheless, it is poorly known by dermatologists. Its incidence, which is currently increasing since the cessation of BCG vaccination in 2007, raises several issues regarding its pathophysiology, diagnosis and management. PATIENTS AND METHODS: We report two cases of NTM adenitis: one in a 2-year-old girl vaccinated with BCG and one in an unvaccinated 22-month-old boy, in whom a misleading presentation led to delayed diagnosis. The condition progressed to fistula formation and the diagnosis was finally made on systematic cultures of lymph node samples. The time to diagnosis was 2 and 4months, respectively. The girl was treated with erythromycin for 3 weeks and with clarithromycin for 3 weeks; the boy received clarithromycin for 7 weeks and underwent complete surgical excision. DISCUSSION: NTM adenitis preferentially affects girls under 4 years and occurs more frequently in winter and spring. First, the other differential diagnoses, including tuberculosis, must be ruled out by chest radiography. The diagnosis is oriented by the clinical picture, a positive TST and resistance to conventional antibiotics. However, it is only certified by systematic culture or PCR of lymph node biopsies, with screening for atypical mycobacteria being specified. The decrease in child protection by BCG vaccination coincides with the current increase in NTM infections, of which the most frequent is Mycobacterium avium complex (MAC) for cervical adenitis. The reference treatment is surgery. However, alternative treatments (incomplete excision, antibiotics, watchful waiting, etc.) should be considered where surgery fails or there is excessive risk of injury to a branch of the facial nerve. CONCLUSION: Atypical mycobacterial adenitis in immunocompetent children has become an increasingly common infection since the abandonment of BCG vaccination. Improved knowledge of this disease would result in complete surgical excision at an early stage with a lower rate of aesthetic sequelae.

[Circumscribed palmar hypokeratosis (CPM): The diagnostic value of dermoscopy]. / Hypokératose acrale circonscrite (HAC) : utilité diagnostique de la dermoscopie.

BACKGROUND: Circumscribed palmar hypokeratosis (CPH) is a rare skin disease, first described in 2002, associated with sudden localized reduction of the corneal layer. In most cases, it presents as an isolated rounded erythematous palmar lesion on the thenar eminence. We describe the dermoscopic semiology of CPH in 3 cases. PATIENTS AND METHODS: Three patients between the ages of 59 and 72 presented very limited erythematous lesions suggestive of CPH. Dermoscopic examination of these lesions provided similar findings. Biopsy, which was performed in one patient, confirmed the diagnosis of CPH. RESULTS: Two dermoscopic elements of CPH are characteristic: (1) the sides of the lesion have a "stair step" or "geological strata" type of configuration, and the thickness of the different strata varies; (2) the centre of the lesion showed a homogeneous erythematous area with a vascular pattern composed of dotted vessels of the superficial dermis and sometime vascular loops. DISCUSSION: These dermoscopic aspects are characteristic and enable CPH to be differentiated from Bowen's disease or porokeratosis of Mibelli. In Bowen's disease, there is no stair step like aspect to the sides of lesions; further, the centre of the lesion shows glomerular vessels (coiled vessels) and/or globular vessels (small red clods). In porokeratosis, peripheral keratotic "white track" structures comprise a single pigmented channel or a double white line. There is no "stair step" or central vascular pattern. CONCLUSION: The dermoscopic semiology of CPH is highly characteristic and enables differentiation from Bowen's disease and porokeratosis.

[Metameric macular and papular skin mastocytosis]. / Mastocytose cutanée maculopapuleuse métamérique.

BACKGROUND: Mastocytosis is characterised by the presence of abnormal quantities of mastocytes in one or more organs. Although it occurs in systemic forms of mastocytosis, isolated skin involvement is the predominant presentation, particularly in children, in the form of more or less extensive though non-systematic lesions. Herein, we report a case of maculopapular cutaneous mastocytosis that is unusual in terms of its metameric topography. PATIENTS AND METHODS: A 16-year-old youth presented with an erythematous maculopapular rash of 18 months' duration and involving pruritic inflammatory episodes strictly localised in segment T8 to the left. The skin biopsy showed a significant increase in the number of dermal mastocytes (CD117+). No KIT mutations were found in the skin lesions nor in the unimpaired skin of the opposite side. Further investigations ruled out systemic mastocytis. DISCUSSION: Herein, we report a case of cutaneous mastocytosis that is unusual in terms of its metameric disposition. There have been only two previous reports of segmental cutaneous mastocytis. The two pathological hypotheses involved precessional dermatitis that renders the skin surface susceptible to homing, and somatic mosaicism (type 1) with local mastocyte proliferation.

A comparison of human metapneumovirus and respiratory syncytial virus WHO-defined severe pneumonia in Moroccan children.

Acute respiratory infections remain the principal cause of morbidity and mortality in Moroccan children. Besides bacterial infections, respiratory syncytial virus (RSV) and human metapneumovirus (hMPV) are prominent among other viruses due to their high prevalence and association with severe clinical episodes. We aimed to describe and compare RSV- and hMPV-associated cases of WHO-defined severe pneumonia in a paediatric population admitted to Morocco's reference hospital. Children aged 2-59 months admitted to the Hôpital d'Enfants de Rabat, Morocco meeting WHO-defined severe pneumonia criteria were recruited during 14 months and thoroughly investigated to ascertain a definitive diagnosis. Viral prevalence of RSV, hMPV and other viruses causing respiratory symptoms was investigated in nasopharyngeal aspirate samples through the use of molecular methods. Of the 683 children recruited and included in the final analysis, 61/683 (8·9%) and 124/683 (18·2%) were infected with hMPV and RSV, respectively. Besides a borderline significant tendency for higher age in hMPV cases, patients infected with either of the viruses behaved similarly in terms of demographics, patient history, past morbidity and comorbidity, vaccination history, socioeconomic background and family environment. Clinical presentation on arrival was also similar for both viruses, but hMPV cases were associated with more severity than RSV cases, had a higher risk of intensive care need, and received antibiotic treatment more frequently. RSV and hMPV are common and potentially life-threatening causes of WHO-defined pneumonia in Moroccan children. Both viruses show indistinctive clinical symptomatology, but in Moroccan children, hMPV was associated with a more severe evolution.

[Prevalence of allergic rhinitis in a rural area of Settat, Morocco]. / Prévalence de la rhinite allergique en milieu rural à Settat (Maroc).

We evaluated the prevalence of allergic rhinitis in a rural population of Settat and its relationship with intestinal parasitosis and living conditions. The sample comprised 336 subjects living in 3 clusters. Rhinitis was evaluated using the ISAAC questionnaire. Prevalence of rhinitis was 37.8%. It was higher in those aged 15-49 years, illiterate subjects, active smokers, those presenting with overweight and those with hypereosinophilia. It was significantly lower in children < 10 years. Rhinitis was associated with sibship size and literacy, but not with intestinal parasitosis and helminth infections.

[Malignant acanthosis nigricans associated with cholangiocarcinoma]. / Acanthosis nigricans malin révélant un cholangiocarcinome.

INTRODUCTION: Acanthosis nigricans is a dermatosis characterized by the presence of a hyperpigmented, velvety cutaneous thickening in the flexural areas, especially axillary and inguinal fossas, and lateral faces of the neck. AN is usually a benign condition but can sometimes reveal an internal malignancy corresponds to a cutaneous paraneoplasic syndrome. Literature shows a predominant association with gastric adenocarcinoma. Here, we report a rare association between AN and cholangiocarcinoma. CASE REPORT: We report a 43-year-old woman who presented an extensive AN associated to a tripe palms syndrome and florid cutaneous papillomatosis. She consulted in dermatology because of the itchiness of the lesions as well as for esthetics reasons. Complementary investigations enabled to diagnose a cholangiocarcinoma without visceral metastasis and she was treated by tumor resection and chemotherapy. Consequently, a slight improvement of the skin condition and the disappearance of pruritus were observed. CONCLUSION: AN should be considered as cutaneous sign either of malignancy or endocrinopathy and therefore requires further investigations. The existence of extensive lesions, pruritus, tripe palms syndrome, florid cutaneous papillomatosis or mucous lesions, associated to an AN is a sign of malignancy should be investigated urgently the early diagnosis of which can lead to a better prognosis.

Les brûlures électriques par haut voltage de l'enfant, à propos de trois cas.

High-voltage electrical burn injuries are rare emergencies in pediatric units and always associated with a poor prognosis. Recklessness, lack of knowledge about electric currents and the lack of safety around public electricity infrastructures are the three main factors contributing to the occurrence of high-voltage electrical accidents in children. Mortality is due to acute cardiac and renal complications, and trauma associated with falls. Secondary evolution is dominated by the risk of infection and the severity of functional sequelae. Early diagnosis and prompt treatment is needed to prevent these complications. Therapeutic management is based on early resuscitation and surgical management of tissue damage. We report three cases of high-voltage electrocution in children, with electro-thermal burns associated with severe head injury in one case, and myocardial damage and a compartment syndrome with severe functional sequelae in the other two. These three case reports are an opportunity to discuss literature data.

Intestinal parasitosis and use of untreated wastewater for agriculture in Settat, Morocco.

An evaluation was made of the risk of contamination by faecal parasites in the population from the use of wastewater in agriculture. The study was based in 3 rural clusters in the northern region of Settat city, Morocco: 2 rural clusters exposed to untreated wastewater in agriculture and 1 not exposed. The sample comprised 333 people aged 3-60+ years: 214 exposed and 119 non-exposed. Stool samples were collected and examined for intestinal parasites. The results showed that the prevalence of intestinal parasitosis (i.e. evidence of at least 1 type of parasite) in the exposed group was significantly higher that the non-exposed group (66.4% versus 31.9%; relative risk 2.1). The household crowding index was also higher in the exposed group.

[Pemphigus vulgaris and intraepithelial neoplasia localized to the vagina]. / Pemphigus vulgaire et néoplasie intra-épithéliale de localisation vaginale.

BACKGROUND: Involvement of the vaginal mucosa in pemphigus vulgaris is a rare occurrence. Here we report an original case that resulted in discovery of intra-epithelial neoplasia at the same site. PATIENTS AND METHODS: A 63 year-old woman was followed for 18 years for pemphigus vulgaris treated with prednisone, initially in combination with azathioprine. An erosive lesion was discovered in the pouch of Douglas during routine gynecological examination and demonstrated the histological features of pemphigus, despite remission of the disease at other sites. In spite of resumption of azathioprine and prednisone, the vaginal lesion continued to spread. A further biopsy revealed intra-epithelial vaginal neoplasia together with images of suprabasal cleavage and acantholysis. Surgical removal was carried out. DISCUSSION: Intra-epithelial carcinoma associated with pemphigus vulgaris has been described in rare cases in the cervix but never in the vagina.

[Prevalence of Giardia intestinalis in a farming population using sewage water in agriculture, Settat, Morocco]. / Prévalence de Giardia intestinalis chez une population rurale utilisant les eaux usées à des fins agricoles à Settat, Maroc.

OBJECTIVE: This investigation was undertaken to assess the risk linked to the use of raw sewage waters in agriculture, and the prevalence of Giardia intestinalis. DESIGN: The survey was made on 214 individuals, average age 28.6+/-19.4 years, belonging to two douars using raw sewage waters in agriculture, and 119 individuals, age 31.8+/-19.5 years, belonging to a control douar not using raw sewage waters. These three douars are located in around the city of Settat, in Morocco. Every consenting individual was given a complete clinical examination and 3 stools samples were collected in 3 consecutive days. RESULTS: The prevalence of G. intestinalis in the exposed population was 11.7% compared to 2.5% in the control population. The relative risk was 4.6. This difference is statistically significant. The most concerned individuals were essentially children between 3 and 14 years of age. Close contact was an important factor of infection in the exposed population, with a higher prevalence in the case of high promiscuity index. In the exposed population, more than 50% of the cases were familial ones. Giardiasis causes a trophic state, essentially in children. CONCLUSION: The use of the raw sewage waters in agriculture is responsible for an increased risk of giardiasis. Some preventive measures are mandatory, including hygiene education and an adequate treatment of sewage waters.

[Perthes syndrome secondary to an asthma attack: A case report in a 15-year-old child]. / Syndrome de Perthes secondaire à une crise d'asthme : à propos d'un cas chez un enfant de 15 ans.

Perthes syndrome, or traumatic asphyxia syndrome, is a rare clinical entity, associating cyanosis, cervicofacial petechiae and subconjunctival hemorrhage. It is usually secondary to chest trauma, but can occur in any situation of abrupt rise in intrathoracic pressure with closed glottis. In this paper, we present a case of Perthes syndrome that triggered an asthma attack for a child during surgery.

The use of a germene for the synthesis of esters of alpha-germyl-substituted alpha-amino acid and alpha-aminophosphonic acid.

The first alpha-germyl-substituted alpha-amino ester and alpha-germyl-substituted alpha-aminophosphonic ester have been synthesized by a one-pot reaction between the germene Mes2Ge=CR2 (CR2 = fluorenylidene) and the iminoester or iminophosphonate Ph(H)C=NCH2-Y (Y = COOMe, P(O)(OEt)2).

The dosing-time dependent influence of chronic cyclosporin A treatment on daily profiles of plasma glucose and insulin in the Wistar rat.

The dosing-time dependent effects of cyclosporin A (CsA) on glucose and insulin plasma levels were evaluated in the light of possible alterations of their biological rhythms. Male Wistar rats weighing 200-250 g were habituated to a 12:12 h light-dark cycle. At the beginning of the experiments, on day D0 (before any treatment), significant rhythms were obtained for plasma glucose and immunoreactive insulin (IRI). The plasma glucose showed a 12 h periodicity and the plasma IRI a more pronounced rhythm, with both 12 h and 24 h significant components. Plasma glucose and IRI were then determined in drug-treated (20 mg CsA/kg b.wt/day; dosing time point: T01, T07, T13, or T20) and control rats during and after a 21-day treatment period. The CsA-treated rats developed hyperglycemia and a marked enhancement of the amplitude of the daily glucose rhythm. The magnitude of these effects differed among the groups (p < 0.001). Most pronounced alterations were observed on day 21 (D21) in group T07: M = 22.5 +/- 4.0 mmol/l; A = 9.2 +/- 6.0 mmol/l. The mean plasma insulin showed little though significant (p < 0.01) decreases. For instance, on D21 in group T01, M = 28.5 +/- 3.6 microU/ml, and in group T07, M = 28.7 +/- 2.5 microU/ml. In parallel, plasma CsA levels increased during the 21-day period and differed among groups (p < 0.01). The highest levels (4-5 mg/l) were obtained in T07 and T19 on D21. After drug cessation, the levels of plasma glucose were reduced, but stayed higher than control values. Body weights were monitored; the rate of growth was lower (p < 0.01) in CsA-treated rats than in controls (2.93 +/- 0.11 versus 5.1 +/- 0.11 g/day, respectively).

A case of temporal arteritis with intrahepatic arterial involvement.

We report a case of temporal arteritis associated with anicteric cholestasis. Serial sections of a transthoracic needle biopsy of the liver revealed giant-cell arteritis in medium-sized hepatic arteries and cholangitis in adjacent bile ducts. The literature reveals that similar pathologic features have only exceptionally been observed in liver biopsies. These lesions may account for liver function disturbances commonly seen in temporal arteritis or polymyalgia rheumatica.

[Calcifying fibrous pseudotumor]. / Pseudo-tumeur fibreuse calcifiante.

The case of a 17-year-young woman with Calcifying Fibrous Pseudotumor is reported. This observation emphasizes 1) A distinctive histologic appearance and the broad spectrum of this entity, 2) The differential diagnosis to consider, 3) The excellent prognostic and the low risk of local recurrence.

[Esophageal foreign body revealed by respiratory distress]. / Détresse respiratoire révélant un corps étranger œsophagien méconnu.

Ingestion of a foreign body is usually accidental in children. Respiratory symptoms, often favored by the persistence of the foreign body in the esophagus, can be revealing, but rarely respiratory distress as a method telling. We report a case of unrecognized esophageal foreign body revealed by respiratory distress.

[Traumatic asphyxia or Perthe's syndrome. About two paediatric cases]. / Syndrome d'asphyxie traumatique ou syndrome de Perthes: à propos de deux observations pédiatriques.

The traumatic asphyxia or Perthes' syndrome is a condition characterized by a classic triad involving head and neck cyanosis, subconjonctival bleeding, and petechiae. The pathophysiology of traumatic asphyxia is different in children compared to adults, because of the greater elasticity of the thorax in children. The purpose of this paper is to describe through two cases of traumatic asphyxia in young children the characteristics of this disease in children.

[Spontaneous intracerebral haemorrhage secondary to congenital factor XIII deficiency]. / Hémorragie intracérébrale spontanée secondaire à un déficit congénital en facteur XIII.

Deficiency of coagulation factor XIII is a rare anomaly. The risk of intracranial haemorrhage is particularly high at any age, either spontaneously or during minor trauma. We report a case of spontaneous intracerebral haemorrhage in a child carrying a known deficiency of factor XIII.

[Severe tetanus complicated with rhabdomyolysis and acute renal failure: a pediatric case report]. / Tétanos grave compliqué de rhabdomyolyse et d'insuffisance rénale : à propos d'une observation pédiatrique.

Renal failure is a rare complication of tetanus in children. It occurs following poorly controlled muscle spasms and rigidity. We describe a severe case of tetanus complicated with rhabdomyolysis and acute renal failure in a child.

[Rigid bronchoscopy for pin extraction in children at the Children's Hospital in Rabat, Morocco]. / Bronchoscopie rigide pour extraction d'épingle chez l'enfant à l'hôpital d'enfants de Rabat, Maroc.

PURPOSE: The aim of this work is to present the clinical and therapeutic aspects of pin inhalation in the airways, as well as the benefit of rigid bronchoscopy for extraction in children. MATERIALS AND METHODS: Five hundred and twenty-four cases of inhaled foreign body are identified in the multipurpose pediatric intensive care unit in the children's hospital in Rabat between January 2005 and December 2010. Thirty-six (6.8%) of them are due to pin inhalation. A retrospective study was conducted to define the epidemiological characteristics, clinical treatment and outcome of pin inhalation in the airways. RESULTS: Thirty-six cases of pin inhalation are identified, all females. The age varies from 10 to 15 years. The consultation period is 2 days. Symptoms are dominated by coughing and stinging sensation. In 61.11% (22 cases), the pin is lodged in the right airways, in 22.22% (eight cases) in the left airways and in 5.5% (two cases) at the trachea. In 63.8% (23 cases), the pin is removed at the first attempt. We did not record any severe complications. No deaths recorded. CONCLUSION: Pin inhalation is a common occurrence in young girls. The extraction can be done safely by rigid bronchoscopy under general anesthesia. Particular attention should be paid to prevention and educational programs to reduce the incidence of pin inhalation.