COVID-19 and Pulmonary Tuberculosis Coinfection in a Moroccan Patient with Pulmonary Embolism: A Case Report and Literature Review.

Emerging cases of coinfection of coronavirus disease 2019 (COVID-19) and tuberculosis (TB), although rare, have attracted the attention of health systems around the world and have arisen many concerns about the diagnosis, treatment, and prognosis of this coinfection especially in high TB burden countries. Here, we report a rare case and, to the best of our knowledge, the first reported case in Morocco of simultaneous diagnosis of an active pulmonary TB infection and a COVID-19 pneumonia. We present a case of a sixty-seven-year-old male patient who was admitted to our COVID-19 emergency department with a diagnosis of COVID-19 pneumonia, confirmed by nasopharyngeal swab's polymerase chain reaction (PCR) for detection of SARS-CoV-2. The atypical radiological findings suggested a TB coinfection which was later confirmed by sputum cultures and Xpert MTB/Rif assay. The patient also presented some complications including thrombosis of the left leg, pulmonary embolism and inaugural ketosis. Treatment was administered as per local protocols: broad spectrum antibiotics, corticosteroids, fixed dose-combination of antituberculosis treatment along with hydration and insulin therapy for ketosis treatment and anticoagulation. The patient was discharged after twenty-three days of hospitalization. Due to the currently limited data, further studies are necessary to establish any possible correlation between COVID-19 infection and the progression of a latent and/or the severity of an active TB infection.

Surgical management of chronic osteomyelitis with benign osteopetrosis: A case report.

INTRODUCTION: Osteopetrosis is a rare genetic bone disease caused by a functional abnormality of the osteoclasts. Until now there is no codified management for the complications of this pathology and few cases cited in the literature. PRESENTATION OF CASE: a 19-year-old adult followed in our maxillofacial surgery department in the IBN ROCHD University Hospital for chronic osteomyelitis complicating mandibular osteopetrosis with skin fistulas. Patient operated several times. The persistence of osteomyelitis prevents the installation of a dental prosthesis and the appearance of new fistulas with continuous flow of pus alters the patient's quality of life. DISCUSSION: Osteopetrosis is a group of rare genetic diseases characterized by osteoclastic insufficiency, poor bone remodeling and increased bone density. the benign form of osteopetrosis called Albers-Schönberg disease. It is a genetically inherited autosomal dominant disease.The large number of surgical interventions and the use of antibiotics for long periods of time (risk of development of resistance) significantly reduces the quality of life of patients. We must seek other measures to improve the prognosis and codify management. CONCLUSION: In osteopetrosis, the maxillofacial surgeons should be aware about the early diagnosis and the appropriate management of the signs and prevent complications.

Cutaneous adenoid cystic carcinoma of lower eyelid: Case report of a rare malignant entity.

INTRODUCTION: cutaneous adenoid cystic carcinoma is a rare epithelial tumor with slow development, it is most often described in the scalp; palpebral involvement is very rare. And is accompanied by local aggressiveness and frequent recurrence. The aim of this work is to discuss the management and the interest of a close surveillance of adenoid cystic carcinoma. CASE PRESENTATION: The authors report a case of palpebral cystic adenoid carcinoma in a 65-year-old patient who underwent surgical excision followed by reconstruction of the loss of substance. DISCUSSION: Cutaneous cystic adenoid carcinoma of the eyelids remains a very rare entity that must be evoked in front of a nodular cutaneous palpebral tumor that progresses slowly. An early diagnosis and a complete excision guarantee a better prognosis. CONCLUSION: Adenoid cystic carcinoma, because of its local aggressiveness and its capacity to recur despite satisfactory surgical removal, requires long-term surveillance. Its surgery may be responsible for functional and aesthetic sequelae.

Seborrheic keratosis of the cheek simulating squamous cell carcinoma.

INTRODUCTION: Seborrheic keratoses are benign tumours that occur electively on the head, neck and trunk. It can be confused on its clinical appearance with other skin tumours and it is the histological examination that establishes the diagnosis. We report a case of seborrheic keratosis simulating squamous cell carcinoma. OBSERVATION: A 62-year-old woman consulted for a budding right jugal lesion that had been evolving for 6 months. Clinical examination found a right jugal budding lesion with crusts on its surface, pedunculated, surrounded by a hyperpigmented halo at its base, firm to palpation, painless and non bleeding on contact. An initial biopsy of the lesion for histological examination confirmed the diagnosis, followed by complete surgical excision. DISCUSSION: Seborrheic keratoses are benign tumours that occur mainly in subjects over 50 years of age. They occur electively on the trunk, head and neck. Its clinical aspect is generally typical but sometimes misleading, as found in our case; only histology allows to make the diagnosis of certainty.

Lingual primary tuberculosis mimicking malignancy.

INTRODUCTION: The constant increase in the incidence of tuberculosis, as long as the emerging global resistance to antituberculous drugs warrants an increased awareness of the possibility of Mycobacterium Tuberculosis in persistent lesions of the oral cavity. Lingual tuberculosis is a rarely described entity of extra pulmonary tuberculosis. It usually presents as a non-healing chronic mucosal lesion that may mimic malignant lingual neoplasms. CASE REPORT: In the present paper, we report a rare presentation of lingual tuberculosis in a 36 years old woman, which was clinically suspected as an extensive malignant fissure of the tongue. The diagnosis was confirmed by tongue biopsy and the patient responded well to the antitubercular chemotherapy. DISCUSSION: lingual tuberculosis is a rare clinical and pathological entity of extrapulmonary tuberculosis. Only a few cases have been reported around the world, and in each one of them, a unique clinical form has been described. This variability of clinical presentations can allude to several pathological conditions including malignancy. CONCLUSION: This case report is a documentation of a unique clinical and radiological presentation of lingual tuberculosis; it also highlights the importance of considering tuberculosis in the differential diagnosis of chronic tongue lesions.

Congenital bilateral zygomatico-maxillo-mandibular fusion associated with gumfusion: Case report.

INTRODUCTION: Maxillomandibular sygnathia is a rare and severe craniofacial deformity defined by gingival mucosal fusion (synechia) or bony fusion (synostosis). CASE REPORT: We will present a case of complete closure of the mouth since birth from eastern Morocco treated in our department of maxillofacial surgery at the University Hospital of Casablanca. The patient was referred after two months by the pediatrician of the provincial hospital and following the placement of a nasogastric tube. On admission, she presented with facial dysmorphosis, signs of malnutrition with closure of the mouth and fusion of both gums with pro-alveoli and retromandibulia. CT scan with 3D reconstruction confirmed maxillomandibular synostosis. 5 days later, she underwent a fixed mucosal incision with osteotomy at the maxillomandibular joints with early and prolonged active physical therapy. The evolution was marked by the recurrence of mouth closure, the little girl was operated a second time and then she died by a mucous plug at the level of her tracheostomy cannula during resuscitation. DISCUSSION: Maxillomandibular sygnathia is a very rare pathology whose origin remains unknown. Very few cases published in the literature. CONCLUSION: The therapeutic difficulties encountered outside the ideal age of the operation and the management of recurrences were also linked to socio-economic factors making it difficult to ensure adequate postoperative follow-up.

Orbital myeloid sarcoma misdiagnosed for subperiostal hematoma: a case report.

BACKGROUND: Myeloid sarcoma is a solid tumor that consists of immature myeloid cells occurring at an extramedullary site. It can present before, concurrent with, or after the diagnosis of acute myeloid leukemia or other myeloproliferative diseases, and a proportion of patients never develop bone marrow infiltration. Only a few isolated cases of pediatric orbital myeloid sarcoma have been reported, and they are often associated with a high misdiagnosis rate. CASE REPORT: We report a rare case of pediatric orbital myeloid sarcoma associated with blunt trauma in a 3-year-old Caucasian male patient, which was clinically and radiologically misdiagnosed for orbital subperiostal hematoma. The patient underwent a surgical intervention to drain the hematoma when an orbital mass was found. The microscopic, immunologic, and genetic features of the tumor and the myelogram were in favor of LAM2, and the patient was started with chemotherapy with a favorable evolution within 18 months follow-up. CONCLUSION: Orbital myeloid sarcoma usually exhibits clinical and radiological features that can be easily misleading, especially if it happens de novo or as the first manifestation of acute myeloid leukemia. Only a few isolated cases have reported and proposed trauma as a trigger event of the onset of this type of tumor proliferation, but further investigations and evidence are needed to support this hypothesis.

Cervicofacial cellulitis on vascular malformation: About two case reports.

Cervicofacial cellulitis is a brutal and dreadful disease that poses a serious problem in terms of therapeutic management. Most often, these cellulitides occur either in a fragile environment or after inappropriate initial management. We report two (02) observations of cervicofacial cellulitis in patients with vascular malformation of the face. In both cases, the patients were previously diagnosed with a facial vascular malformation and presented with secondary cervicofacial cellulitis homolateral to the vascular malformation. The diagnosis of cellulitis was made by clinical and biological elements and confirmed by imaging (CT). This comorbidity remains a rare entity, and almost not reported in the literature; their management remains however complex and must be integrated with multidisciplinary consultations.

Unusual cervicofacial localization of two subcutaneous tuberculous cold abscesses in an immunocompetent subject.

INTRODUCTION: Subcutaneous tuberculous cold abscesses represent a rare form of extra-pulmonary tuberculosis and their cervicofacial localization is exceptional. The management of this unusual form and location is medico-surgical and must be adapted to avoid progression to complications. CASE REPORT: We report the case of a double cervicofacial localization of subcutaneous tuberculous cold abscesses in an immunocompetent patient followed for pulmonary tuberculosis who benefited from a surgical drainage of the two abscesses with anti-tuberculosis treatment with good clinical evolution. DISCUSSION: The diagnosis of subcutaneous tuberculous cold abscesses is based on a combination of anamnestic, clinical and paraclinical findings. Cold abscesses are most commonly described in patients with disseminated tuberculosis or during human immunodeficiency virus infection, but they may also occur in immunocompetent subjects. Monofocal localization is the most common and the association of several localizations is unusual. The treatment is medical-surgical, combining surgical drainage with anti-tuberculosis treatment. CONCLUSION: Subcutaneous tuberculous cold abscesses should be considered in the presence of any stubborn collection occurring in a context of tuberculosis infection. Early diagnosis is the best guarantee of a cure without complications.

Ameloblastoma giant: Diagnosis, treatment and reconstruction: A case report.

INTRODUCTION: Ameloblastoma is a rare tumor, benign but rapidly extensive and prone to recurrence. Its management remains difficult and its treatment relies mainly on surgery. For giant ameloblastoma or in people with an advanced stage the gesture remains very mutilating. PRESENTATION OF CASE: This is a 22 year old patient, the onset of the symptomatology dates back to 2 years ago with the appearance of a mandibular swelling that increased in size with dental mobility. this motivated the patient to consult a CT scan and a panoramic radiograph as well as a biopsy that objectified an ameloblastoma. He benefited from a surgical excision with reconstruction. DISCUSSION: It is a rare tumor that mainly affects young people and especially males. It can be discovered by chance or generally in front of a mandibular swelling. Radiological examination is essential as well as biopsy to confirm the diagnosis. The treatment is surgical, which consists of an exeresis with safety margins. Reconstruction should be discussed especially for young healthy subjects. CONCLUSION: Although ameloblastoma remains a benign tumor, it is a tumor that evolves rapidly and recurs a lot, which is why it is necessary to take care of it quickly with a radical treatment and a regular follow-up with the patients.

Well-differentiated liposarcoma of the cheek misdiagnosed for lipoma: A case report.

INTRODUCTION: Liposarcoma is the most common sarcoma entity and accounts for 17% to 30% of soft tissue sarcomas. There are several histological types including well-differentiated liposarcoma. This paper aims to underline the interest of immunohistochemical and cytogenetic studies to diagnose well-differentiated liposarcoma and to show the delicacy of performing a surgical procedure in the cheek area. CASE PRESENTATION: The authors report the case of a 48-year-old female patient who presented with the recurrence of a right jugal mass initially diagnosed as a lipoma on the resection specimen. The patient was reoperated 5 years later and further immunohistochemical and cytogenetic studies confirmed the diagnosis of well-differentiated jugal liposarcoma. DISCUSSION: Sarcomas are rare malignant tumors of mesenchymal origin, arising from connective and supporting tissues. It should be noted that certain MRI features can distinguish liposarcoma from lipoma. Conventional histology and immunohistochemistry are the basic means for the diagnosis and classification of liposarcomas. However, molecular biology can add to the pathologist's analysis and rule out differential diagnoses Liposarcoma of the maxillofacial region has a better prognosis compared to other parts of the human body. CONCLUSION: This paper underlines the interest of complementary immunohistochemical and cytogenetic studies to differentiate well-differentiated liposarcoma from lipoma as well as the potential for local recurrence of liposarcomas.

Neglected ballistic trauma of the face in a young subject: A case report.

Injuries by ballistic projectiles concern nowadays more and more frequently civilian populations. If the vital prognosis is rarely put at risk, the functional after-effects are frequent and important. The management of these injuries follows specific rules that must be known because they are sometimes different from the usual traumatology. However, it is important for any surgeon to understand the basic principles of ballistic injury. Indeed, the knowledge of the trajectory of the bullet and its final location allows to consider the potential injuries and to evaluate the management of the patient. CT is the examination of choice for penetrating foreign bodies, allowing for viewing of the entry site, bullet trajectory, possible scattered fragments, and, most importantly, a possible skull base breach, as well as providing useful information for planning the surgical procedure and, generally, for prognosis. The primary surgery must ensure an early and rigorous trimming associated with antibiotic therapy because the quality of the initial trimming significantly influences the final result, so this approach to the removal of the foreign body depends on its size, its anatomical location, the structures involved and the preference of the surgeon.

Nasal syringocystadenoma papilliferum in an elderly subject aggravated by Koebner's phenomenon after surgery: A case report.

Syringocystadenoma papilliferum is a rare benign adnexal tumour of the sweat glands. It is considered an infantile tumour since it preferentially affects the newborn in 50% of cases and the child before puberty in 15-30% of cases. And its preferential location is the head and neck, but rare in the face. And the first line treatment remains surgery. We report here a case of Syringocystadenoma papilliferum in a nasal location in a 70 year old subject with a history of pemphigus vulgaris, treated by surgical excision, whose postoperative course was aggravated by Koebner phenomenon.

Contralateral traumatic carotid cavernous fistula after a craniomaxillofacial fracture.

INTRODUCTION: Carotid-cavernous fistula is an abnormal communication between the internal carotid artery, the external carotid artery or any of their branches and the cavernous sinus. This condition may occur spontaneously or after craniofacial trauma; in this case the fistula takes place on the same side as the craniofacial fracture and becomes symptomatic within a few weeks. The diagnosis is clinical; it must be evoked before any post-traumatic proptosis. Treatment must be started quickly to avoid visual or even vital complications. CASE PRESENTATION: We report the case of a 19 years old male patient who was admitted to the maxillofacial surgery department for osteosynthesis of a fracture of the left orbital roof after a traffic accident. The three-month's examination noted a right pulsatile proptosis with redness and decrease of the visual acuity. The cerebral MRI was in favor of a right sided direct CCF, which was confirmed by the arteriographie. The patient responded very well to embolization. DISCUSSION: Craniofacial trauma is a major cause of carotid cavernous fistula. When a patient has ophthalmic manifestations of vascular complications, early detection of CCF is important for preserving visual acuity. The diagnosis is mainly clinical based on the ophthalmological symptoms. CT and MRI scans show the indirect signs of the fistula. There are several types of invasive and non-invasive treatments. The evolution of the fistula is generally favorable and recurrence is not very frequent. CONCLUSION: This case report is a documentation on an exceptional case of posttraumatic direct CCF occurring on the contralateral side of the skull base fracture.