Cutaneous tuberculosis in children from the northeastern region of Morocco.

INTRODUCTION: In Morocco, tuberculosis is an endemic disease. The aim of this study was to trace the epidemiological, paraclinical, therapeutic, and progressive characteristics of cutaneous tuberculosis (CT) in children. MATERIALS AND METHOD: This multicenter retrospective and prospective study concerned all pediatric patients followed for CT in our region. The diagnosis was based on comparing clinical, immunological, bacteriological, and histological data. RESULTS: We found 147 cases of CT, of which 16 cases (10%) were children. The average age was 10.5 years, with extremes ranging from 15 months to 16 years. The sex ratio was 0.75. Deterioration in general condition and weight loss were noted in three cases, and none of the patients was immunocompromised. The clinical forms were essentially scrofuloderma tuberculosis in nine cases (57%), gummas in five cases (35%), a single case each of verrucous tuberculosis and lupus vulgaris. The histological study of the lesions confirmed the diagnosis for all cases by showing a tuberculous granuloma. Multifocal forms were found in one case. Antibacillary treatment was recommended for 6 months in all patients except in the child with a multifocal form whose treatment was prolonged to 9 months. The progression was favorable with total healing in all cases except in a single case that retained sequelae such as bone deformities and scars in most cases. DISCUSSION: Cutaneous tuberculosis in children is dominated by scrofuloderma and gummy lesions in our region. Despite deterioration in the general condition and weight loss in three cases, none of these children was immunocompromised. Therapeutic management was then carried out based on several clinical and paraclinical arguments and the histological study. Even if the compulsory BCG vaccine in Morocco prevents serious forms, early diagnosis remains the only way to reduce the risk of complications. CONCLUSION: Cutaneous tuberculosis concerns our pediatric population, multibacillary forms of cutaneous localization is the most frequent one, although the BCG vaccine in Morocco is compulsory.

[Lichenoid drug eruption with antituberculosis drugs associated with an anonychia]. / Toxidermie lichénoïde aux antituberculeux associée à une anonychie.

INTRODUCTION: Lichenoid cutaneous reactions to antituberculosis drugs are rare. Herein we report a new case. PATIENTS AND METHODS: A 41-year-old patient was seen for a profuse and pruriginous rash occurring 2 weeks after administration of rifampicin and isoniazid for pulmonary tuberculosis. Dermatological examination revealed polymorphic erythemato-squamous plaques with lichenoid, psoriatic and eczematous features, associated with cheilitis, erosions on the cheeks and diffuse onychodystrophy. The skin biopsy confirmed a lichenoid reaction. The pharmacovigilance investigation incriminated isoniazid and rifampicin. The patient was treated with topical corticosteroids and UVB phototherapy. The outcome involved complete regression of the eruption but with secondary anonychia. DISCUSSION: Antituberculosis drugs including isoniazid and rifampicin are known to induce lichenoid reactions. It is difficult to distinguish the results from lichen planus. The clinical polymorphism of the rash as well as the patient's drug intake militate in favour of a diagnosis of lichenoid reaction. Widespread ungual involvement, which is extremely rare, warranted early management in order to avert irreversible anonychia.