Madurella mycetomatis infection of the foot: a case report of a neglected tropical disease in a non-endemic region.

BACKGROUND: Mycetoma is an uncommon chronic granulomatous infection of cutaneous and subcutaneous tissues that can be caused by filamentous bacteria (actinomycetoma) or fungi (eumycetoma). It is the prerogative of young men between the third and fourth decade and is transmitted through any trauma causing an inoculating point. The classic clinical triad associates a painless hard and swelling subcutaneous mass, multiple fistulas, and the pathognomonic discharge of grains. Although endemic in many tropical and subtropical countries, mycetoma can also be found in non-endemic areas as in Morocco, and causes then diagnosis problems leading to long lasting complications. Therefore, we should raise awareness of this neglected disease for an earlier management. Under medical treatment however, mycetoma has a slow healing and surgery is often needed, and relapses are possible. CASE PRESENTATION: Herein we report a case of a 64 years old patient, with a history of eumycetoma occurring ten years ago treated with oral terbinafine coupled with surgery. A complete remission was seen after 2 years. He presented a relapse on the previous scar 6 months ago. There wasn't any bone involvement in the magnetic resonance imaging (MRI). The patient was put under oral terbinafine with a slow but positive outcome. CONCLUSION: Through this case report, we perform a literature review and highlight the importance of increase awareness of mycetoma in clinical practice especially in non-endemic regions.

Addictive behaviors, cardiovascular and metabolic comorbidities in North African psoriatic patients: case-control study.

We propose to study the epidemiological aspects of North African psoriasis and determine the cardiovascular comorbidities and addictive behaviors associated with psoriasis. This is a North African case-control study which was conducted over a five year period (October 2008 through August 2013), involving 671 psoriatic patients and 1,242 controls identified in various Algerian, Tunisian and Moroccan university hospitals. For each patient, epidemiological characteristic, addictive behaviors, and cardiovascular pathologies associated with psoriasis were noted. Six hundred and seventy one psoriasis patients and 1,242 controls were included in this study. The average age was 47.24 years and the M/F sex-ratio was 1.11 (354 men and 317 women). Statistical analysis showed that psoriasis patients were more likely to develop addictive behaviors than controls (smoking p<10-5 and alcohol consumption: p < 10-5), together with dyslipidemia (30.1% of patients p < 10-5), obesity (23.8% of patients p < 10-4), hypertension (22.3% of patients p < 10-5), diabetes (21.7% of occurrences p < 10-5) and metabolic syndrome (37.4% of patients p<10-5). The relative risk for developing psoriasis was 1.9 in hypertensive patients, 1.7 in diabetic patients, 3.9 in dyslipidemic patients, 1.8 in obese patients, 2.6 in those with metabolic syndrome, 2.1 in smokers and 2.8 in alcoholics. Our work confirms the high incidence of addictive behaviors and of cardiovascular and metabolic comorbidities during the North-African psoriasis, hence the need for a multidisciplinary comprehensive care based on a guideline suited to the characteristics of North-African psoriatic patients.

[Widespread miliaria crystallina: about a case]. / La miliaire cristalline généralisée: à propos d'un cas.

Prickly heat is a benign cutaneous manifestation due to the obstruction of the sweat ducts following excessive exposure to heat, humidity or hyperthermia. We report the case of a 70-year old diabetic female patient treated with insulin, hospitalized in the Intensive Care Unit due to acidocetosic coma secondary to pyelonephritis. The patient had diffuse clear vesicular lesions spread all over the body,(a) firm to palpation, on a healthy skin, suggesting miliaria crystallina. Miliaria crystallina is a benign cutaneous manifestation due to sweat retention secondary to obstruction of the sweat ducts. It is possible to distinguish between miliaria crystallina due to the obstruction in the stratum corneum, miliaria rubra due to the obstruction within the malpighian stratum and miliaria profunda due to an obstrusction in or below the dermoepidermal junction, depending on the level of obstruction. Miliaria crystallina heals spontaneously in a few hours giving rise to a desquamation, as occurred in our patient after regression of febrile syndrome.

[Black henna tattoo: risk of developing allergic contact eczema]. / Tatouage au henné noir: attention à l'eczéma de contact.

Henna is used for coloring hair, but also to draw labile skin tattoo. Henna is often mixed with paraphenylenediamine (PPD). We report the case of a female patient presenting with contact eczema due to labile tattoo containing PPD. The study involved a 23-year old young woman with an aesthetic Black Henna tattoo on the back of the hand and on the forearm. This labile tattoo contained PPD. Two days later, the patient developed intensely pruritic, burning erythematovesiculosus and edematous lesions. The lesions involved the tattooed area, corresponding with the original drawing. The lesions were improved using Class 1 of topical corticosteroids (Clobetasol propionate). The patient refused allergy patch testing, so no allergy test was performed. Now, henna is very popular in the western countries. PPD is added to reduce the fixing time or to obtain a darker coloration. It can result in severe systemic reactions. The most frequent allergic reaction is contact dermatitis. Treatment is based on local corticosteroid therapy. A better regulation on labile tattoo, the control of preparations as well as a regular annual information for the general public are essential. The interest of our study lies in highlighting the importance of informing, especially young people, on the risks of labile tattoo.

[Cutaneous ulceration: metastases should be suspected]. / Ulcération cutanée: penser aux métastases.

We report the case of a 68-year old patient, with a history of chronic smoking, presenting with cutaneous swelling at the level of the anterior chest wall evolving over a period of 5 months and gradually increasing in size. It was associated with gradually worsening exertional dyspnoea evolving in a context of an alteration of general state and 15kg weight loss. Mucocutaneous examination objectified rounded, well-defined cutaneous swelling measuring 5cm x 5cm, with erythematous border and with ulcerated surface (A). Lymph nodes examination showed two painless, mobile, bilateral axillary adenopathies with a firm consistency, each measuring 2cm. Histological and immuno-histochemical examination of skin biopsy specimen showed adenocarcinoma compatible with a lung origin (B and C). Chest CT scan confirmed the presence of left lingular pulmonary process (D). The therapeutic approach was based on pemetrexed + platinum salt chemotherapy. The patient died 4 months after the diagnosis of the disease.

What do you think of an unusual axillary mass?

Skin apocrine carcinoma is a rare malgnancy of epidermal adnexa, most frequent in axillary seat, where apocrine sweat gland are abundant, the neoplasm can arise in groin, anogenital, lips, eyelid, characterized by a plate or surface area of nodules hummocky. Etiology and incidence are not known. The prognosis is influenced by the risk of locoregional recurrence and metastatic evolution. We describe the case of 61-year-old man who presented a left axillary slow-growing mass since 2 years ago. The cutaneous biopsy objectified an apocrine adenocarcinoma. The paraclinic exams performed to detect primary breast were tumor negative, first step before confirming the diagnosis. Standard treatment is surgical excision with margins of 2 to 3cm for local tumor, for apocrine adenocarcinoma regional lymph node dissection if nodes were clinically positive is wide surgical excision. This kind of tumour is chemoresistant. In this case, adjuvant chemotherapy was indicated, before surgery to reduce tumoral volume. This case illustrates the importance clinicopathological correlation of skin cancer, particularly apocrine one. Clinical particularity and careful analyses histology helps diagnosis approach.

External ear nodule revealing a disseminated Kaposi disease.

Kaposi disease (KD) is an angiogenetic tumor process, characterized by its various clinical aspects. Its pathogenesis is multifactorial and it was attributed to HHV-8 infection. We report an original case of disseminated KD revealed by solitary lesion of external ear in a patient treated by corticosteroids for bullous pemphigoid.