Uremic pericarditis in patients with End Stage Renal Disease: Prevalence, symptoms and outcome in 2017.

The prevalence of uremic pericarditis (UP) used to range from 3% to 41%. More recently, it has decreased to about 5%-20% and to <5% in the last decades, as hemodialysis techniques have become widely used and dialysis quality improved. The objective of this work is to determine the initial clinical picture and the prognosis of patients presenting End Stage Renal Disease (ESRD) with UP. MATERIALS: This is a retrospective study (May 2015-September 2017). Inclusion criteria targeted patients who had uremic pericarditis defined as pericarditis occurring in a patient with ESRD before initiation of renal replacement therapy, or within eight weeks of its initiation. RESULTS: 16 patients met the inclusion criteria. The median age of patients was 54 [24, 71] years and 56.2% were male. Pericardial effusion was small, moderate and large in 31.2%, 37.6% and 31.2% of cases respectively. One pericardiocentesis was performed in view of a clinical picture of impending cardiac tamponade and three pericardial drainages were performed given presentation of tamponade. Hemodialysis was initiated for all the patients and continued for 2 to 3weeks until complete regression of the pericardial effusion. The mean number of dialysis sessions was 11±3.5. One patient died of septic shock that developed three weeks after diagnosis of uremic pericarditis. CONCLUSION: UP is considered a rare but fatal complication of ESRD because of the risk of tamponade and its prognosis remains dependent on early diagnosis and adequate treatment of ESRD.

[Multiple facial nodules revealing disseminated cryptococcosis in an immunocompetent patient]. / Nodules multiples du visage révélant une cryptococcose disséminée chez un patient immunocompétent.

BACKGROUND: Cryptococcosis is a potentially severe infection that usually occurs in a setting of immunosuppression. Its occurrence outside of this context is rare. We report a case of disseminated cryptococcosis revealed by a spectacular skin disease in an immunocompetent patient. PATIENTS AND METHODS: A 40-year-old male patient had been presenting multiple nodules and tumors on his face for one month in a context of asthenia and intermittent fever. Histological examination of a skin biopsy revealed encapsulated yeasts strongly suggestive of Cryptococcus neoformans. Mycological examination of the skin biopsy and cerebrospinal fluid isolated Cryptococcus gattii. The blood cultures were positive. Brain MRI demonstrated cryptococcal parenchymal involvement. Screening for primary or secondary immunodeficiency was negative. The patient received amphotericin B 1mg/kg/day and fluconazole 600mg/day but died 2months after diagnosis. DISCUSSION: Cryptococcosis is a potentially severe infection caused by C. neoformans. This rare condition occurs most commonly in patients with profound deficiency in terms of cellular immunity. Although rare, the occurrence of cryptococcosis in immunocompetent patients is possible, and in this event the signs are highly polymorphic, which usually makes it very difficult to diagnose. The diagnosis of cryptococcosis is based on the identification by direct examination and after staining with India ink of encapsulated yeasts of the Cryptococcus genus. Culture on Sabouraud medium is essential for identification of the species. Treatment for disseminated cryptococcosis involves amphotericin B, often associated with flucytosine IV. In the event of meningitis infection in non-HIV patients, mortality continues to be around 15%, despite adequate medical treatment. CONCLUSION: Although rare, cryptococcosis can occur in immunocompetent subjects. The prognosis is severe even after treatment.

Syndrome De Lyell Et Syndrome De Stevens-Johnson: Étude Rétrospective De 30 Cas.

Stevens-Johnson syndrome and Lyell syndrome are severe bullous drug reactions that can be life-threatening. The aim of this study is to describe the epidemiological, etiological, clinical, therapeutic and evolutionary data of patients hospitalized in our Dermatology Department. This is a retrospective descriptive study over a period of 10 years. All records of patients admitted to the Dermatology Department for these cutaneous adverse drug reactions were included. A total of 30 patients were recorded, with a male predominance. There were 18 cases of Lyell syndrome, 8 cases of Stevens-Johnson syndrome and 4 cases of overlap syndrome. The mean time to onset after drug administration was 7.5 days. The average skin area detached was 48%. Visceral involvement was frequently observed: pulmonary involvement, renal involvement, hepatic cytolysis and hematological involvement. The notion of medication was found in all our patients, with self-medication in 23% of cases. The reason for prescription was dominated by post-surgical anticonvulsant prophylaxis. All our patients received symptomatic treatment, and corticosteroid therapy was administered in only one patient for macrophagic activation syndrome. The mortality rate was of 17%. Skin area involved, presence of renal failure or respiratory distress were the main prognostic factors.

Clinicopathological features of adult right-sided cardiac masses: Analysis of 19 cases.

Background: Right sided cardiac masses are rare. The purpose of this study is to review the clinical experience and pathological characteristics of right-sided cardiac masses and to provide a prognostic analysis in our hospital. Methods: We retrospectively reviewed 19 consecutive cases of right heart masses diagnosed in our institution from 2016 to February 2020. All available clinicopathological features, imaging characteristics and disease outcomes were summarized and presented. Results: The subjects included 9 men and 10 women with a mean age of 48.5 years. The most frequent complaint was dyspnea. The most common site was the right atrium (42.1%) followed by the tricuspid valve (36.8%). Clinical diagnosis revealed vegetations in 8 patients (42.1%), thrombi in 7 patients (36.8%), myxoma in 1 patient, hydatid cyst in 1 patient and metastatic (secondary) masse was seen in 2 cases. In the 19 patients, 3 patients underwent surgery, 15 patients were managed with medical treatment, therapeutic abstention was indicated in one patient. 14 patients were all alive at the end of the follow-up period. In contrast, 5 patients were dead (26.3%). Conclusion: In our series, the majority of right cardiac masses were benign, outnumbering the malignant ones, as described in the literature. The mortality rate was relatively high about 26.3%.

[Generalized bullous pemphigoid induced by radiotherapy]. / Pemphigoïde bulleuse généralisée induite par une radiothérapie.

BACKGROUND: There have been a very small number of reported cases of radiotherapy-induced autoimmune bullous disease. We describe a case of generalised autoimmune sub-epidermal bullous pemphigoid (BP) induced by radiotherapy in a female patient presenting squamous cell carcinoma of the vulva. CASE REPORT: In June 2008, a 48-year-old woman underwent vulvectomy with lymph node curettage for squamous cell carcinoma of the vulva. Following surgery, adjuvant radiotherapy was indicated. At the 16th session (dose of 32 Gy), erythema occurred on the irradiation field. At the 23rd session (46 Gy), the patient presented bullous lesions that became generalised after four days with involvement of the oral mucosa. Skin biopsy revealed sub-epidermal bullae and direct immunofluorescence showed continuous linear deposits of IgG and of C3 along the dermal-epidermal junction. Indirect immunofluorescence revealed the presence of antibodies directed against the basement membrane. A favourable outcome was achieved under systemic corticosteroids. No immunotransfer analysis of serum or any other immunological investigations were performed. DISCUSSION: The clinical and histological features of this autoimmune bullous disease were evocative of BP, despite the absence of any formal proof. Radio-induced BP is extremely rare, with only 28 cases being described to date in the literature. The trigger mechanism is poorly understood; radiotherapy appears to cause changes in the antigenic properties of proteins in the dermal-epidermal junction resulting in production of autoantibodies. The radio-induced nature of BP does not affect therapeutic response. The case we report is novel in terms of both generalisation of the eruption and mucosal involvement.

[Iatrogenic Kaposi's disease in Morocco in a non-transplant context]. / La maladie de Kaposi iatrogène au Maroc en dehors du contexte de la transplantation.

BACKGROUND: Kaposi's disease (KD) is a multifocal disease affecting the skin and viscera. KD can occur in an endemic setting: it may be associated with human immunodeficiency virus (HIV) or it may occur as a complication of immunosuppression, particularly of iatrogenic origin in transplant patients. The purpose of this study is to describe the epidemiological, clinical and therapeutic profile and the course of iatrogenic KD in Morocco in a setting not involving organ transplantation. PATIENTS AND METHODS: A retrospective study conducted at the dermatology department of the Ibn Sina hospital centre in Rabat, Morocco, covering a 21-year period and including 14 patients presenting histologically confirmed iatrogenic KD. RESULTS: Eight men and six women were included with a mean age of 56 years. All patients received corticosteroids, in combination with cyclophosphamide in three cases and with azathioprine in one case. The mean time to onset of lesions after the start of treatment was 16.5 months. The presentation in all cases was cutaneous. Impaired mucosal membrane was seen in 35.7% of patients, with visceral involvement being seen in only one patient. HIV serology tests were negative in all patients but HHV8 serology tests were positive in 78.5% of patients. Treatment consisted primarily of reduction or withdrawal of the immunosuppressant. The outcome was favourable in the majority of cases. CONCLUSION: In Morocco, KD is a rare but not exceptional complication of immunosuppressant therapy, particularly corticosteroids. The disease presented as a skin disorder in all of our patients, thus emphasising the value of regular follow-up and routine dermatological examination of patients on immunosuppressant therapy, and suggesting the value of screening for HHV8 infection before initiating such therapy.

[The role of chemotherapy in the management of bladder cancer]. / Rôle de la chimiothérapie dans la prise en charge du cancer de la vessie.

Bladder cancer represents for man the second genitourinary cancer after prostate cancer. Urothelial carcinoma is the most predominant histological type. In up to 70% of the cases, the diagnosis of bladder cancer is performed at early stages (Ta-T1). In this situation, the treatment of the disease is the transurethral resection with or without intravesical treatment (BCG, Amiticyne). In advanced disease, treatment is essentially palliative with chemotherapy based on cisplatin type MVAC (methotrexate, vinblastine, doxorubicin, and cisplatin) or gemcitabine-cisplatin. In invasive stages (T2-T3-T4), the radical cystoprostatectomy combined with urinary diversion for man, and the pelvectomy for woman are the gold standard. However, over 50% of these patients experienced metastatic recurrence during their evolution, which prompted investigators last 10 years to assess the value of néoadjuvant chemotherapy in their management. Indeed, neoadjuvant chemotherapy is now recognized as a standard by numerous American and European institutions. However, adjuvant chemotherapy remains controversial even for patients with lymph node involvement. The purpose of this literature review is to highlight the role of chemotherapy in the management of urothelial carcinoma of bladder with locally advanced and metastatic disease. The role of targeted therapies alone, in combination with chemotherapy, and in maintenance, is being evaluated.

Patent foramen oval: A rare case of acute ischemia of the upper limb: A case with 2 year follow-up.

INTRODUCTION AND IMPORTANCE: Paradoxical emboli (PDE) represent less than 2% of all arterial emboli, that is why they are considered as a rare event. We notice that the upper limb ischemia is very exceptional as part of a paradoxical embolism. This case presentation can help in considering the diagnosis the PFO as one of the most important risk factors of paradoxical embolism. CASE PRESENTATION: Here, we present a rare case of a 69-year-old woman with paradoxical systemic arterial embolism, presented by an acute ischemia of the upper limb, secondary to deep venous thrombosis and pulmonary embolism in the presence of patent foramen ovale, treated with long-term anticoagulation with rivaroxiban 20 mg/day, because of the mutation of the Factor II whish indicate already the anticoagulation. DISCUSSION: Echocardiographic techniques such as transthoracic echocardiography (TTE), transesophageal echocardiography (TEE), or transcranial echocardiography (TCE) are the principal tools used to detect PFO. There are no clear consensus on the treatment of PDE. Presenting symptoms largely depend upon the location of the embolus, necessitating a different approach for each patient, but There is essentially three therapeutic options: surgical embolectomy, thrombolysis, and anticoagulation. CONCLUSION: PFO closure is, today, a standardized and safe intervention, but the indication stay individualized to each patient.

Acute myocarditis related to Covid-19 infection: 2 cases report.

INTRODUCTION AND IMPORTANCE: Since COVID 19 was described for the first time in December 2019, we have not stopped discovering its different clinical manifestations. Despite the respiratory complication which is the most common symptomatology, multi-organ dysfunction and multiple cardiovascular complications were described such as acute myocarditis, heart failure and even arrhythmias. CASES PRESENTATION: Two patients aged 26 and 56 year-old, developed acute myocarditis related to Covid-19 infection but with different symptomatology. CASE 1: Presented to the emergency room with digestive symptomatology, Covid-19 infection was confirmed by a positive chest CT scan and positive COVID-19 serology testing. Clinical, biological, radiological findings allowed making the diagnosis of a Covid-19 infection with a bacterial superinfection complicated by a fulminant myocarditis. CASE 2: Presented to the emergency department with a chest pain, dyspnoea, paroxistic cough, myalgia and fever. A Covid-19 infection was confirmed. The electrocardiogram showed a diffuse ST elevation, echocardiography showed normal systolic function and the high-sensitivity cardiac troponin I level was high. Invasive coronary angiography was performed, revealing angiographically normal coronary arteries. CLINICAL DISCUSSION: Our 2 cases were treated differently, case 1 received antibiotherapy because of the bacterial superinfection and inotropic support for the septic and cardiogenic choc. Contrarily to case 2 who received inotropic support, immunoglobulin and corticosteroid. With a total recovery for both patients. CONCLUSION: This article can help in considering cardiac affection due to SARS-CoV2, even with poor respiratory symptomatology, and to insist on the importance of the cardiac evaluation for young patients with a sever Covid-19 infection.

Results of a public awareness campaign in Morocco regarding the sun's deleterious effects.

OBJECTIVE: To investigate knowledge of the various sun radiation-related risks and awareness of photoprotection measures using a sample of the Moroccan population. METHODS: An investigation of prevalence, which was administered while a public awareness campaign on the sun's harmful effects, organized by the department of dermatology of Ibn Sina's hospital in Rabat, was running. The collection of the data was made on the basis of a questionnaire that was filled by the team of the doctors of the department. The logistic regression allowed to identify the explanatory factors for the prevalent knowledge and behaviours related to the subject in hand. RESULTS: Four hundred eleven subjects were included in the survey. The subjects' average age was 40 +/- 10 years. Eighty-four per cent were female. The analysis of the total score of knowledge related to the sunrays' deleterious effects demonstrated low levels of knowledge among 160 participants (38.9%). Females were clearly more knowledgeable than the opposite sex (P = 0.003) and also those having a higher educational level (P = 0.006) scored high. The use of sunscreens was recognized by 52.8% of the patients and was associated with female gender and higher educational level. CONCLUSION: Our study reports the results of the first public awareness campaign on the sun's deleterious effects on the Moroccan population, inclusive and relevant to all ages. Awareness of the sun's radiation-related risks in a country as sunny as ours is low, whereas different measures of photoprotection are rather well known. Messages adapted to the characteristics of our population are a necessity.

[Fixed food eruption caused by liquorice]. / Erythème pigmenté fixe induit par de la réglisse.

INTRODUCTION: Fixed drug eruption is a characteristic cutaneous adverse reaction that recurs at fixed localisations. It is due to medical drugs. However, food may sometimes be responsible for a similar eruption, known as "fixed food eruption". We report a case of fixed food eruption due to liquorice. CASE REPORT: A 22-year-old woman presented with liquorice-induced fixed drug reaction. Topical challenges remained negative both at previously affected sites and in unaffected skin. Therapeutic re-exposure to liquorice confirmed the diagnosis. DISCUSSION: To our knowledge, we report the first case of food drug reaction caused by liquorice.

[Baker Rosenbach erysipeloid appearing as a granulomatous cheilitis]. / Erysipéloïde de Baker-Rosenbach prenant l'aspect d'une chéilite granulomateuse.

BACKGROUND: Baker-Rosenbach's erysipeloid is a skin infection caused by Erysipelothrix rhusiopathiae. It occurs essentially in humans exposed to animals colonized with this germ such as swine. The typical skin lesion, an erythematous macule generally localized to inoculation site, frequently in the extremities, quickly resolves spontaneously. The lips are an atypical site of this infection. We describe a case of chronic granulomatosis cheilitis in a farmer caused by E. rhusiopathiae. CASE REPORT: A 40-year-old farmer, a wild-boar hunter and chronic smoker with no history of tuberculosis, injury or insect bites, presented at our dermatology unit with ulcerative macrocheilitis of the lower lip ongoing for 1 year. Its surface was purulent. A biopsy specimen showed non-caseating epithelioid granulomas. Laboratory and radiological screening for tuberculosis, sarcoidosis and Crohn's disease, and parasitological examination for Leishmaniasis proved negative. Bacteriological examination identified E. rhusiopathiae and labial Baker-Rosenbach's erysipeloid was diagnosed. The lesion healed after 15 days of treatment with parenteral penicillin G (12m IU/d), totally disappearing after 3 months. DISCUSSION: Swine erysipelas usually occurs in man as Baker-Rosenbach's erysipeloid. This localized form of infection with E. rhusiopathiae is the most frequent and the lesion typically observed is a violaceous plaque, less inflammatory with induration; spontaneous regression occurs after a mean 3 months. To our knowledge, this case is the first report of ulceration associated with macrocheilitis. Histologically, the granuloma directed our investigation towards the principal aetiologies of granulomatosis cheilitis, such as tuberculosis considering the epidemiological context, sarcoidosis or Crohn's disease. The diagnosis of erysipeloid was supported by epidemiological evidence (occupational exposure), isolation of the germ at the lesion and its regression on treatment with penicillin G. CONCLUSION: Diagnosis of E. rhusiopathiae infection was confirmed by bacteriology. However, the hypothesis concerning the pathogenesis of its chronic course in our patient remains a subject of discussion.