[Primary breast tuberculosis in a man: a case report]. / Tuberculose mammaire primitive chez un sujet de sexe masculin : à propos d'un cas.

The breast tuberculosis accounts for 0.06 to 0.1% of extra-pulmonary localizations. Frequent in women, it remains exceptional in men. We report a rare case of primary breast tuberculosis occurring in a male patient. A 33-years-old patient presented with a chronic and fistulized non-inflammatory-right breast swelling with an atrophic cutaneous ulceration. The thoracic CT was in favor of a right breast abscess with a thick wall. The patient had received non-specific antibiotics (amoxicillin-clavulanate and metronidazole) for 10 days coupled with a surgical drainage before consulting us for persisting symptoms. The culture of the pus was sterile, the GeneXpert and the search for acid-fast bacilli (AFB) both performed on the swab of the ulceration were negative. Histopathological analysis of the lesion was in favor of a granulomatous mastitis. Given the chronic and atrophic nature of the ulceration, the histological aspect of granulomatous mastitis and the persisting symptoms despite the non-specific antibiotic therapy, we made a presumptive diagnostic of breast tuberculosis. The evolution was favorable with oral anti-tuberculosis treatment.

Mycetoma epidemiology, diagnosis management, and outcome in three hospital centres in Senegal from 2008 to 2018.

Mycetoma is a neglected tropical disease caused by various actinomycetes or fungi. The disease is characterized by the formation of tumor like-swellings and grains. Senegal is an endemic country where mycetoma cases are under-or misdiagnosed due to the lack of capacities and knowledge among health workers and the community; and where the management of eumycetoma, burdened by a high amputation rate, is currently inadequate. This study aimed to update data on the epidemiology of mycetoma cases diagnosed in three hospital centres in Senegal over a 10 years-period. A total of 193 patients, diagnosed from 2008 to 2018, were included in the study. The most frequent presentation was eumycetoma (47.2%); followed by actinomycetoma (36.8%); it remained undetermined in 16.1% of the patients. The mean age was 38.3 years (68.4% of the patients were between 15 and 45 years-old); the male: female ratio was a 2.94; and most were farmers. One hundred fifty-six (80.8%) patients had used phytotherapy before attending the hospital. Mycetoma was mainly located to the lower limbs (91.2%). Grains were observed in 85% of the patients; including white (25.6%) and yellow (4.3%) grains. The etiological diagnosis was complex, resulting in negative direct microscopy, culture and/or histopathology findings, which explains that 16.1% remained uncharacterized. In most of cases, actinomycetoma were treated with a combination of cotrimoxazole, amoxicillin/clavulanic acid, and streptomycin; whereas eumycetoma cases were treated with terbinafine. The surgery was done in 100 (51.8%) of the patients including 9 in actinomycetoma, 78 in eumycetoma and 13 in undetermined form. The high number of uncharacterized mycetoma in this study, the delay in attending a qualified health-care facility, and the lack of available adequate antifungal drug, point out the need to strengthen mycetoma management capacities in Senegal.

[Cutaneous tuberculosis affecting the buttock in an immunocompetent adult patient]. / Une histoire de fesse: cas d'une tuberculose gommeuse de la fesse chez un adulte immunocompétent.

Tuberculosis is an endemic disease in Senegal. It rarely affects the skin. In these patients it is characterized by clinical polymorphism. It accounts for 2% of extra-pulmonary tuberculosis. We here report the case of an immunocompetent patient with tuberculosis affecting the buttock characterized by lesions gummy in consistency revealing active pulmonary involvement. This study involved a 47-year-old man admitted for a painful swelling in the right gluteal region that had evolved for four years. Physical examination objectified a polyfistulized hardened plaque characterized by confluent nodules and discharge of yellowish pus in the lower and inner face of the right buttock associated with bilateral inguinal inflammatory adenopathies. The diagnosis of skin tuberculosis was retained based on histological examination which showed tuberculoid granuloma and the detection of Alcohol-Acid Resistant Bacilli (BAAR) in the gastric fluid. Thoracoabdominopelvic CT scan showed multiple bilateral basal lung micronodules with a "bud tree" appearance. Serologic testing for HIV and HBV were negative. The patient achieved recovery after six months of tuberculosis treatment. In endemic areas, skin tuberculosis is characterized by clinical polymorphism. It should be suspected in patients with perineal abscess lesion.

[Epidemiological and anatomoclinical features of scalp tumors in black Africans]. / Aspects épidémiologiques et anatomo-cliniques des tumeurs du cuir chevelu chez le noir africain.

INTRODUCTION: In Senegal, the studies on scalp tumors are almost non-existent. The purpose of our study was to determine the epidemiological and anatomoclinical features of scalp tumors in dermatology. METHODS: We conducted a prospective descriptive and analytical study in both Department of Dermatology at Dakar over a period of 16 months (01 March 2014-30 June 2015). Histopathological examination was used to confirm the diagnosis. RESULTS: We collected data from the medical records of 36 patients, of whom 14 had malignant tumors and 22 benign tumors. Sex ratio was 1.1, the average age of patients with malignant tumors was 51 years while the average age of patients with benign tumors was 39 years. Hospitalization rate was 0.18%. The average time of consultation in patients with malignant tumors was 14 months, while in patients with benign tumors was 52 months. In 11 patients with malignant tumors, first treatment was based on traditional therapy. Malignant tumors included: squamous cell carcinoma (n=8), basal-cell carcinoma (n=3), lymphoma, hidradenocarcinoma and Darier-Ferrand dermatofibrosarcoma (one case for each type). Benign tumors included: botriomycoma (n=5), trichilemmal cyst, sebaceous hamartoma, cylindroma and lipoma (2 cases for each type), heloid, syringocystadenoma papilliferum, schwannoma, neurofibroma and nevus (one case for each type). Tumor malignancy was associated to ulcero-budding appearance (p=0.003), diameter >4 cm (p=0.05), pain (p=0.009) and bleeding (p= 0.006). CONCLUSION: Scalp tumors in black people are usually benign. Squamous cell carcinoma is the most common malignant form.

Extranodal natural killer/T-cell lymphoma, nasal type, in Senegal.

INTRODUCTION: The distribution of extranodal NK/T-cell lymphoma (ENKTCL) is highly inhomogeneous throughout the world. In Sub-Saharan Africa, despite the precocity of Epstein-Barr virus (EBV) infection and its endemicity, ENKTCL remains exceptionally reported. The purpose of this study was to report the epidemiological, clinical, paraclinical, and evolutionary characteristics of ENKTCL at the Aristide LeDantec University Hospital in Dakar, Senegal. METHODOLOGY: A 5-year retrospective review of all patients with histopathological, immunohistochemical, and in situ hybridization proven cutaneous lymphomas RESULTS: We collected seven cases corresponding to a frequency of 1.4 cases per year. ENKTCL accounted for 10.5% of all cutaneous lymphomas, ranking second after T-cell lymphomas. Men were predominantly affected (M : F ratio of 6), and the mean age was 38.5 years ± 4.06. The mean time before consultation was 7.3 months. The lymphomas affected primarily the nasal cavity in five cases and the skin in two cases. At admission, six patients had nasal mucosa involvement, which was isolated in three cases, associated with cutaneous lesions in three cases and lymph node involvement in three cases. CD56 was positive in only one case, and Eber transcribed RNA of EBV was expressed by in situ hybridization in all patients. DISCUSSION: To our knowledge, we have reported the first and largest series of ENKTCL in Sub-Saharan Africa. Our study shows an intermediate prevalence between that reported from Asia, Latin America, and the West. It was also noted a young age of patients, a prolonged diagnostic delay, a frequent negativity of CD56 marker, and a very poor prognosis of the disease in our region.

[Endemic Kaposi's sarcoma in Dakar: 29 cases]. / Maladie de kaposi endemique a Dakar: etude de 29 cas.

INTRODUCTION: There is a lack of data on endemic Kaposi's sarcoma in sub-Saharan Africa. The goal of this study was to clarify its epidemiological, clinical and therapeutic aspects in that region. PATIENTS AND METHODS: A 7-years retrospective study, including all patients with endemic Kaposi's disease diagnosis was carried out. RESULTS: We identified 29 cases of endemic Kaposi's representing 1.2% of total hospitalizations and an incidence of 4.4. The mean age and the sex ratio were 63.2 years 2.22 respectively. The average delayed time to seek for medical care was 6.75 months. Cutaneous manifestations were dominated by angiomatous papulonodular lesions in 15 cases (51.72%) ulcerated lesions in 8 cases (27.58%), lymphedema in 5 cases (17.24%), a sarcomatous degeneration in 2 cases and verrucous papules in one case. Mucosal involvement was observed in 7 cases (24.13%). The extracutaneous lesions were noted in 18 cases, with 6 cases of bone, 5 cases of lymph nodes, 5 cases of gastrointestinal and 2 cases of lung involvement. The outcome was favorable for single-agent chemotherapy with bleomycin in more than half of the cases. Recurrences were observed in 2 patients, 2 cases were died and 7 cases never came back. CONCLUSION: Endemic Kaposi's disease is more frequent in elderly people with a higher frequency of extracutaneous involvement and florid forms.

INTRODUCTION: En Afrique sub-saharienne il existe peu de données concernant la maladie de kaposi endémique. L'objectif de ce travail, était de préciser ses aspects épidémiologiques, cliniques et thérapeutiques. MALADES ET MÉTHODES: Une étude rétrospective d'une durée de 7 ans, recensant tous les malades présentant une maladie de kaposi endémique. RÉSULTATS: Nous avions recensé 29 cas de maladie de kaposi endémique représentant 1,2% des hospitalisés soit une fréquence annuelle de 4,14 cas par an. La moyenne d'âge était de 63,2 ans et le sex-ratio de 2,22. Le délai moyen de consultation était de 6.75 mois. Les manifestations cutanées étaient dominées par les lésions papulo-nodulaires angiomateuses dans 15 cas (51,72%), de lésions ulcérées dans 8 cas (27,58 %), d'un lymphœdème dans 5 cas (17,24%), une dégénérescence sarcomateuse sans 2 cas et des papules verruqueuses dans un cas. Les localisations muqueuses étaient notées dans 7 cas (24,13%). Les atteintes extracutanées notées dans 18 cas, étaient osseuses dans 6 cas, ganglionnaires dans 5 cas, digestives dans 5 cas et pulmonaires dans 2 cas. L'évolution était favorable sous monochimiothérapie à la bléomycine dans plus de la moitié des cas. Les récidives étaient observées chez 2 malades, des perdus de vus dans 7cas et 2 cas de décès. CONCLUSION: La maladie de kaposi endémique prédomine chez les personnes âgées avec une fréquence élevée des atteintes extracutanées et des formes florides.