Twenty-nine cases of lupus vulgaris.

UNLABELLED: Cutaneous tuberculosis (TB) is a rare presentation of extrapulmonary TB. Lupus vulgaris (LV) is a common presentation of cutaneous TB. OBJECTIVE: We aimed to describe the epidemiological, clinical, paraclinical, therapeutic, and outcome features of LV in the region of Sfax, Tunisia. PATIENTS AND METHODS: We conducted a retrospective and descriptive study of LV case patients observed at the dermatology department of the Hédi Chaker Hospital (Sfax) over a 34-year period. RESULTS: A total of 88 cutaneous TB case patients were identified during the study period, including 29 patients presenting with LV. All patients had clinical features of the most common presentation of LV. The results of skin biopsies indicated tuberculoid granulomas without caseous necrosis. Patients received TB treatment. LV progressed to squamous cell carcinoma in one patient. CONCLUSION: In Tunisia, endemic country for TB, LV should be considered in patients presenting with an old skin lesion.

[Treatment of keloid with phenol: a new therapy]. / La phénolisation: un nouveau traitement des chéloïdes.

PURPOSE: Evaluation of a new treatment for keloid scars using a 40% phenol solution in accordance with a predefined protocol. PATIENTS AND METHODS: A retrospective study was made of the files of 25 patients treated with phenol from June 2010 to March 2012. RESULTS: The keloids were located predominantly on the trunk (48%) and upper extremities (34%). The total number of keloids was 52, with a median size of 11.16 cm(2). Phenol was the sole and first-line treatment in 40% of cases. Patient adherence to the protocol of phenol was noted in 81% of cases. The mean number of phenol sessions was 14.2. Seventy-two percent of patients were satisfied with the treatment. Mean regression in keloid size of 75.5% was noted. A change in local keloid pigmentation was observed in 75% of patients. Local adverse reactions (itching, infection, ulceration) were seen in 6 patients (28.6%). No cases of systemic signs of phenol were observed. After mean follow-up of 12.8 months, no recurrence of keloids was noted. CONCLUSION: Use of phenols in the topical treatment of keloids appears valuable since it is easy to apply and provides good results with few side effects.

About a challenging tumour, elastofibroma dorsi: an eight-case study.

Elastofibroma dorsi is an uncommon benign soft tissue pseudotumour usually located at the lower pole of the scapula, deep to the serratus anterior and often attached to the periosteum of the ribs. This lesion is usually seen in patients over the age of 50 years and is commonly misdiagnosed as a malignant tumour because of its size and deep location. We describe 8 cases of elastofibroma dorsi diagnosed over a 10-year-period. Our study contained 5 females and 3 males with a mean age at diagnosis of 62.5 years (range 47-75 years). We aim to highlight the clinical and radiologic presentation of elastofibroma dorsi in order to increase awareness of its existence and management.

[Fusariosis diagnosed in the laboratory of an UH in Tunisia: epidemiological, clinical and mycological study]. / Fusarioses diagnostiquées au laboratoire d'un CHU en Tunisie : étude épidémiologique, clinique et mycologique.

The genus Fusarium, initially known for its important agro-economic impact, is more and more often implicated in human pathology. In fact, multiples allergic, toxic and infectious manifestations are more reported in immunocompetent and immunocompromised hosts. The objective of our study was to analyse the epidemiological, mycological and clinical features of fusariosis reported in our CHU. Eighty-seven cases of Fusarium infections were collected: 34 cases of onychomycosis (39%), 26 cases of intertrigos (30%), 25 cases of keratomycosis (29%), one case of atypical invasive fusariosis due to Fusarium oxysporum species complex (FOSC) and one case of localized gingivolabial fusariosis due to Fusarium solani species complex (FSSC) in a patient with leukemia in phase of deep bone marrow aplasia, whose outcome was favorable after exiting of aplasia period and a treatment by amphotericine B. The case of pseudotumoral cutaneous fusariosis to F. oxysporum complicated with osteolysis and septic arthritis occurred in a pregnant woman without any immune deficit. The evolution was fatal in spite of prescription of multiple systemic antifungals. Concerning keratomycosis, Fusarium was the first agent responsible for these infections (43%). The corneal traumatism was found in 37.5% of cases and FSSC was the most isolated (72%). For superficial dermatomycosis, Fusarium was the third agent of onychomycosis in molds (25%). The most isolated species were FSSC (68%) and FOSC (20%). The intertrigo frequency was 0.07% and they were mostly caused by FSSC (84%) and FOSC (16%). Fusarium is an important cause of mold infections in our region. So, the species identification is useful because some species are resistant to the most common systemic antifungal agents.

About the necessity of improving the current nodal classification of non-small cell lung carcinoma.

BACKGROUND: The current classification of lymph node status in non-small cell lung carcinoma has not been revised since 1997. This fact has prompted many authors to point out the limits of this classification. METHODS: We tried to explore the prognostic relevance of the current TNM classification in comparison with the nodal classification based on the ratio of metastatic lymph nodes (LNR) and the nodal classification based on the number of metastatic LNs (nLN). Additionally, we tried to explore the recommended number of resected LNs. This was done through a retrospective study of 39 cases. We compared the survival curves of patients using the current, RLN and nLN classifications. In the nLN classification, we grouped patients into three categories: nNO (no metastatic LNs), nN1 (1 to 2 metastatic LNs) and nN2 (> 2 metastatic LN). In the LNR classification, we grouped patients into three categories: rNO (0%), rN1 (< or = 12) and rN2 (> 12). Concerning the total number of the resected LNs, patients were categorized into two groups according to the number of LNs: < 10 versus > or = 10 and < 15 versus > or = 15. RESULTS: Our results showed that the LNR classification highlighted a difference in prognosis between the rN1 and rN2 groups. Moreover, survival of patients seemed to be better when the number of the resected LNs was higher. CONCLUSION: The ratio of metastatic LNs seems to be an important prognostic factor, but further studies are necessary to standardize this classification.

The efficacy of bronchial washings in diagnosis of lung carcinoma.

BACKGROUND: The accurate diagnosis of lung carcinoma has become compulsory, especially after the introduction of new targeted therapies. The majority of these patients are non-operable, highlighting the importance of the cytology specimen. Our aim was to assess the diagnostic efficacy of bronchial washings in low income countries where this low cost technique is widely performed. MATERIAL AND METHODS: We conducted a study of 118 bronchial washings collected in the Department of Pathology. Bronchial washings were smeared on 5-6 clean slides. These were fixed in 95% ethyl alcohol for haematoxylin and eosin staining. Cases were retrospectively reviewed by two pathologists (FM and MM) together with the corresponding biopsies. False negative cases were reviewed twice, and the diagnosis was reassessed in one case. We calculated the sensitivity (Se), specificity (Sp), positive predictive value (PPV), negative predictive value (NPV) and Yoden index. CONCLUSIONS: Our study showed a sensitivity of 56%, specificity of 90%, PPV of 55%, NPV of 76% and a Yoden index of 0.45. These results emphasise the diagnostic efficacy of bronchial washings and the possibility of performing molecular tests on cytology specimens.

[Scalp ringworm tinea capitis in Tunisian infants]. / Teignes du nourrisson en Tunisie.

OBJECTIVE: The aim of the study was to specify the epidemiological, clinical, and mycological particularities of tinea capitis in infants. DESIGN: We retrospectively collected data from the files of 245 infants presenting with tinea capitis, followed in the Hedi-Chaker hospital dermatology department and in two mycology laboratories of the Sfax hospital, between January 1995 and December 2006. We collected the epidemiological, clinical, and mycological data for each patient. RESULTS: We included 137 boys and 108 girls with trichophytic tinea in 62 % of cases and microsporic tinea in 34 % of cases. Trichophyton violaceum and Microsporum canis were identified by culture respectively in 51 and 37 % of cases. CONCLUSION: Tinea capitis is frequent observed in our region, Trichophyton violaceum and Microsporum canis are the most frequent mycological agents.

[Hypertrophic osteoarthropathy associated with pulmonary tuberculosis]. / Ostéoarthropathie hypertrophique pneumique associée à la tuberculose pulmonaire.

Hypertrophic osteoarthropathy is a syndrome frequently described in intrathoracic diseases, especially malignant ones. The association with lung tuberculosis is rarely reported. The authors describe the case of a 35-year-old patient, a smoker, hospitalised for lung cavitation associated with hypertrophic osteoarthropathy. The assessment of the aetiology was negative and the patient underwent lung surgery. The histopathological examination concluded as to chronic pulmonary tuberculosis. This report aims at alerting physicians about the possibility of hypertrophic osteoarthropathy in non malignant diseases, especially pulmonary tuberculosis which is still endemic in our country.

[Dermatomycosis due to Trichophyton verrucosum in Sfax-Tunisia]. / Les dermatomycoses àTrichophyton verrucosum à Sfax-Tunisie.

UNLABELLED: Trichophyton verrucosum is a zoophilic dermatophyte. It can be responsible of various clinical aspects especially inflammatory lesions of skin and scalp. The aim of this study was to determine the clinical and epidemiological characteristics of dermatophytosis due to T. verrucosum. PATIENTS AND METHODS: It is a retrospective study realized on 35,918 patients suspected to have superficial mycoses in a 13-year-period (from 1998 to 2010). RESULTS: T. verrucosum was isolated in 178 patients corresponding to 1.2% of all dermatophytosis. Ochraceum variety was the most frequent (60%), followed by album variety (40%). Frequency of isolated T. verrucosum increased passing from one case in 1998 to 37 cases in 2010. The mean age was 22.7 years (range: 1.5-71 years). A percentage of 74.2 of our patients were male and 61% were from urban regions. A percentage of 32.5 could link their clinical lesions to contact with an animal (mainly cattle and sheep). Other family members were infected by tinea in 7.3% of cases. Tinea corporis was the most frequent (62.2%), followed by tinea capitis (31.6%). Ten cases of sycosis, one case of tinea pedis and one case of pubic tinea were diagnosed. Lesions of skin were erythemato-squamous (82.5%) and pustulo-inflammatory (17.5%), affecting mainly upper limb (58.3%) and face (25.8%). For tinea capitis, lesions were squamous (30.8%) and pustulo-inflammatory (41%). Eleven cases of kerion celsi were diagnosed (28.2%). Patients were affected in one site (79.7%), two sites (16.9%) and three or more (3.4%). CONCLUSION: Dermatophytosis due to T. verrucosum is in recrudescence in our region. This finding may be explained by changing behaviors and activities of the population with a low socioeconomic level who kept a larger number of domestic animals at homes.

[Atypical cutaneous Fusarium infection in an immunocompetent patient]. / Fusariose cutanée atypique chez un sujet immunocompétent.

INTRODUCTION: Fusarium are filamentous saprophytic brown fungi found in soil, on plants and outdoors. Invasive, necrotic fusarial skin infections are rare and are found in immunodepressed subjects. We report a case in a woman with no discernible immune deficiency. PATIENTS AND METHODS: A 24-year-old woman in good general health, pregnant at 34 weeks amenorrhoea, consulted for ulcerating, budding lesions with a necrotic centre over her entire body, but mainly localised on the cheeks and four limbs. The diagnosis of fusariosis due to Fusarium oxysporum was made on the basis of direct examination and repeated skin biopsy culture. All investigations were normal, and in particular, the patient had no detectable immune deficiency. Treatment was extremely difficult. The patient received amphotericin B, then voriconazole and terbinafine, ketoconazole and finally liposomal amphotericin. DISCUSSION: In immunocompetent subjects, fusarial species generally colonise the corneal layers of the skin. Our case was special in terms of the clinical aspect of the pseudotumoural lesions with a necrotic centre in an immunocompetent woman and in terms of the difficulty in treating her.

First case of Trichophyton soudanense isolated in Tunisia.

This is a first case of Trichophyton soudanense isolated from Ivoiran student in Tunisia. A 24-year-old man was addressed for extensive erythematous, scaling lesions. Examination disclosed tinea capitis, tinea corporis, tinea pedis, and onychomycosis of toenails and fingernails. Isolates were identified as Trichophyton soudanense on the basis of macroscopy and microscopy colony characteristics. The patient was treated with fluconazole, topical econazole, and ciclopiroxolamine varnish. Although T. soudanense was identified since the late 1950s outside the African continent especially in the North America, Brazil, Australia, and many European countries, this is the first case reported in Tunisia. Accessibility to our universities for African students makes possible the emergence of this dermatophyte.