[Basal cell carcinoma: about a historical case]. / Carcinome basocellulaire: à propos d'un cas historique.

We here report the case of an 80 year old man, with clear phototype, villager, residing in one of the most isolated places in our kingdom, located at an altitude above 2400 metres. During humanitarian aid, he presented with ulcero-necrotic tumor infiltrating the nasal root and the right orbit with total destruction of the right eye. The patient reported that the lesion had progressed for two and a half years from a small bleeding papule on the nasal root with orbital spread. Clinical and histological appearance suggested the diagnosis of infiltrating basal cell carcinoma. Staging showed right naso-orbital bone invasion. Mutilating cancer surgery was indicated but the patient refused it. Basal cell carcinoma is reported to have a relatively good prognosis because of its slow and local evolution. However, some cancer types, such as infiltrative tumor occurring in some high-risk areas, including the naso-orbital region, can be rapidly devastating, mutilating and voluminous with aesthetic and functional impairements as well as difficult to manage.

[A rare and atypical cause of scrotal ulcerations]. / Une cause rare et atypique des ulcérations scrotales.

Salmonelloses are bacterial infections of the faecal peril; they are endemic in some regions of the world. They can colonize almost any organ hematogenously, hence, severe forms may be observed. We report a case of typhoid fever in a 16-year old young adolescent with no medical history, sexually transmitted diseases or sexual intercourses, presenting with necrotic scrotal ulcerations evolving over the past 3 weeks in a context of fever, diarrhoea, weight loss and alteration of the general state. Paraclinical assessment showed 7g/dl hypochromic microcyticanemia with target cells in blood smear and normal hemoglobin electrophoresis, biologic inflammatory syndrome, malabsorption syndrome, cytolysis and hepatic cholestasis 20 times above the normal, hepatosplenomegaly, normal viral serologic testing (HBV, HCV, HIV, EBV and CMV) and positive testing for salmonella. The patient underwent 3 weeks of therapy with fluoroquinolones with favorable evolution. Dermatologic manifestations are frequent and polymorphic in typhoid fever; however cutaneous and, in particular, scrotal ulcerations are rarely reported. Differential diagnosis may be based on sexually transmitted diseases, inflammatory bowel diseases or hematologic disorders. More often diarrhoea is reduced or absent and patient's outcome depends on antibiotic. Diagnostic confirmation in patients with an atypical clinical picture, as in the case of our patient, is based on serology. Treatment is based on proper and prolonged antibiotic therapy and on prophylaxis measures to neighbouring.

[Atypical and revelatory livedo reticularis!?] / Livédo atypique et révélateur!?

Atherosclerosis is a frequent and life-threatening complication in elderly patients with multimorbidity as well as with one or multiple cardiovascular risk factors. It can affect all the arterial trunks of the lower limbs and can cause obliterative arterial disease of the lower limbs. We here report the case of an elderly patient with ecchymotic livedo reticularis of the right thigh revealing ipsilateral obliterative arterial disease of the lower limb with septic loosening of total hip prosthesis. The study involved a 70-year old man with favorable atheromatous condition complicated 6 months before by ischemic heart disease revascularized with double prostheses (stent) and with right total hip prosthesis implanted 10 years before. He presented with large mesh and incomplete livedo reticularis associated with ecchymoses on the right thigh (A). Clinical examination showed reduced distal pulses in the right lower limb. Laboratory tests showed discrete inflammatory syndrome and normal haemostatic and immunological tests . Standard radiographic evaluation of the right hip showed a loosening of the distal end of the prosthesis (C). Echo-doppler of the lower limbs and angio-scanner showed occlusion of the right external iliac axis, right double primitive iliac stenosis and a lesion due to septic dislocation of the right femoral prosthesis with abscess collection measuring 48 mm/30 mm ( B). The patient was referred to the Division of Vascular Surgery for revascularization. Vascular imaging by echo-doppler and/or angio-scanner should be performed, in particular in elderly patients with livedo reticularis or venous collateral circulation and with cardiovascular risk factors.

A paraduodenal hernia revealed by bowel obstruction: case report and literature review.

Internal hernias are defined as the protrusion of abdominal viscera through an aperture in the intraperitoneal recesses, they are considered as a rare cause of intestinal obstruction. The paraduodenal hernias are the most common type of congenital hernia especially the left-sided ones. We report a case of a 46 year-old man presenting a left paraduodenal hernia with acute small bowel obstruction, which was firstly (preoperatively) assigned to a tumoral cause.

[Vitiligo revealing Vogt -Koyanagi-Harada disease]. / Vitiligo révélant une maladie de Vogt-Koyanagi-Harada.

Vitiligo is a chronic auto-immune skin disease, often associated or discovers other autoimmune pathologies. His association with Ophthalmological type pan uveitis and/or neurological type of meningitis and/or inner ear type of hearing loss determines the disease or Vogt -Koyanagi-Harada syndrome (VKH). We related the case of a young woman who consulted for recurrent uveitis for a year, and it was only with the onset of vitiligo lesions that VKH disease diagnosis was discussed and confirmed.