Infection ostéo articulaire à pneumocoque chez un sujet apparemment sain

Les infections ostéo-articulaires (IOA) àStreptococcus pneumoniae sont rares chez les adultessains et elles surviennent, souvent, sur un terraind'immunodépression ou de pathologie articulaire.Nous rapportons ici un cas d'arthrite septiquesubaiguë de l'épaule à Streptococcus pneumoniaeobjectivée chez un sujet âgé, sain et chez qui on n'apas objectivé de pathologies sous jacentes qui enpourraient être responsable. Ainsi, le Streptococcuspneumoniae doit être évoqué devant toute infectionostéo articulaire, essentiellement chez les vieillards,même en l'absence des facteurs favorisantsclassiquement associés

[Cervico-facial hydatidosis. report of 17 cases]

Cervico-facial hydatid cyst is rare. It accounts for 1% of echinococcosis locations. To describe the epidemiological, clinical and therapeutic aspects of cervico-facial hydatid cysts based on our clinical experience and data in the literature. A retrospective study was made concerning 17 patients with cervico-facial hydatid cyst treated surgically over a 25-year period from 1982 to 2006. Mean patient age was 27 years [range 2-79]. Hydatid cyst localization was: cervical muscle [7 cases], thyroid gland [5 cases], parotid gland [2 cases], cervico-thoracic [1 case], larynx [1 case] and cheek [1 case]. Hydatic origin of the cyst was suspected for 6 patients [35.3%] preoperatively. Surgical treatment was used in all cases and adapted to each case. Diagnosis was always confirmed by macroscopic aspects and pathology. Hydatid cysts are rarely found in the cervico-facial region, even in highly endemic zone. The manifestation of symptoms depends on the location and the size of the cyst. Positive diagnosis can be difficult during preoperative period. Exclusively surgical treatment is indicated, ideally for total pericystic resection without rupture

[Rosacea: 244 Tunisian cases]

Rosacea is a common, chronic facial dermatosis of uncertain etiology, several well-defined types and variable progression. There is a paucity of epidemiologic studies from North African countries especially in Tunisia. To determine epidemiological, clinical, histological features, treatment and outcome of rosacea in a Tunisian study. A tretrospective study of all rosacea cases diagnosed in the outpatient Dermatology Department of Charles Nicolle hospital of Tunis was conducted between 1990, January and 2003, May. Our study included 244 patients. The diagnosis of rosacea was made on symptoms and clinical features in 185 cases and on histological findings in 59 patients. The hospital prevalence of rosacea was 0.2%. The sex ratio M/F was 0,4. Patient's Mean age was of 49 years. Triggered factors mentioned included most often: sun exposure [64%] and thermal stimuli [25%]. Mean duration between the onset of symptoms and the first consultation was about 20 months. The rosacea subtypes were: erythematotelangiectatic type [12%], papulopustular rosacea [69%], and rhinophyma [3.7%]. Granulomatous rasacea was diagnosed in 8 patients and steroid rosacea in 28 cases. Ocular rosacea was observed in 41 cases. Treatment modalities included: topical treatment [1.6%], systemic treatment [85%], systemic and topical treatment [5%] and surgical procedures [1.2%]. Rosacea seems to be a frequent dermatosis in Tunisia where most of the population is phenotype IV-V. It affects mostly middle-aged women. Most of our patients present with papulopustular rosacea [69%]. More epidemiological and clinical studies in North African countries should be conducted to emphasize these results

[Chronic lupus erythematosus: 104 Tunisian cases]

Chronic lupus erythematosus is a cutaneous form of lupus eryhematosus, usually involving photoexposed areas. The aim of our study is to evaluate the epidemio-clinical trends, therapeutic features and outcome of patients with chronic lupus erythematosus, through a Tunisian hospital series. We have tried to compare our results with those of other African and western series. It is a retrospective study, concerning all patients with chronic lupus erythematosus, attending the Dermatology department of Charles Nicolle Hospital over an 11 years period. The patients' age, sex, clinical features, explorations results, treatment and evolution were recorded. A total of 104 patients were included. Chronic lupus erythematosus represented 0,1% of all the dermatitis seen over 11 years. Chronic lupus erythematosus affects young women with a ratio F/M of 1,97 and an average age of 42 years. The discoid form was the most frequent clinical shape, observed in 73% of cases [76 patients]. The face was the most frequent localization of the lesions [91%]. Five patients [4.8%] presented a generalized chronic lupus erythematosus. The direct immunofluorescence in stick skin was positive in 54% of cases. Treatment included sun avoidance and oral antimalarials drugs in the majority of cases [95%]. The progression from chronic lupus erythematosus to systemic lupus erythemetosus was observed in two cases [2%]. Chronic lupus erythematosus is a relatively are disorder in Tunisia, compared to other African countries, where prevalence is 7 to 10 times more frequent. As shown in our study, the most common clinical feature is the discoid form. The diagnosis can be confirmed by histopathological and direct immunofluorescence examination. Progression of chronic lupus erythematosus to systemic lupus erythematosus is possible, as observed in tow of our patients. Thus, patients with chronic lupus erythematosus should be continually followed up

[Side effects of meglumine antimoniate in cutaneous leishmaniasis: 15 cases]

Leishmaniasis is wide spread parasitic disease considered to be endemic in 88 countries in both old and new world. The standard treatment remains Meglumine antimoniate. We study the side effects of systemic meglumine antimoniate in cutaneous leishmaniasis. We conduct a retrospective study covering 3-year period [2002- 2005]. All medical reports of cutaneous leishmaniasis treated by systemic Meglumine antimoniate are reviewed. The study comprise 63 patients all treated by systemic meglumine antimoniate at the dose of 60mg/kg/day for 10-15 days. Side effects were noted in 15 cases [12 females and 3 males] .The subject's age range from 11 to 78 years. Stibio-intolerance [fever, rash, arthralgia, abdominal pain] was observed in 12 cases and stibio-toxicity in 3 cases: precordialgies 1 case, hyperamylasemia and increase liver enzyme: 1 case, pancytopenia, renal and hepatic failure leading to death: 1 case, skin eruption: 7 cases, pruritis and erythema in the site of injection: 5 cases, urticaria: 1 case. Meglumine antimoniate was stopped in 13 cases Meglumine antimoniate is the generally recommended treatment of cutaneous leishmaniasis. In spite of the rarity of Glucantime's side effects, we recommend a careful survey especially in older patients

Assesssment of cryotherapy by liquid nitrogen in the treatment of hand and feet warts

Cryotherapy with liquid nitrogen is the most widely used method to treat hand aod feet warts. Therapeutic response to this method depends on many factors related to warts and to the patient. The aim of this study is to determine factors influencing therapeutic response of warts to cryotherapy by liquid nitrogen. It was a prospective transversal study including 100 patients with warts of the hands and/or feet treated by cryotberapy with liquid nitrogen [cotton wool bud] and referred to Dermatology Department of Charles Nicolle Hospital of Tunis. Demographic data, so as characteristics of warts were recorded. Patients received one treatment/week with a maximum of 4 sessions. Patients whose warts were seen to be resolved were classified as cured. Cure-predictive factors were studied with a multi varied study with logistic regression. Of the 100 patients [56 females/44 males, Mean age: 22 years], ten were withdrawn. In 89 patients, warts were present on hands, whereas 23 had warts on feet and 12 had warts on both hands and feet. The mean number of warts per patient was 7. The total cure rate was of 64.4%and was more elevated in hands compared to feet [70.8%versus 10.5%], There was no difference between mean ages of cured group and not cured one [22.2 years versus 21 years]. The mean duration of warts in cured patients was lower than that of not cured patients. The mean number of warts before treatment was 4.3 in cured patients and 12.3 warts in not cured patients. The mean number of treatments was 2.3 in cured patients and 4 treatments in not cured patients. The difference between these factors into cured and not cured groups was statistically significant in uni-varied study but not significant in multi-varied one. The effectiveness of liquid nitrogen used by traditional method in the treatment of hand and feet warts seems to depend on multiple factors: warts duration, number of warts and number of treatments. These factors depend on each other

[Localized scleroderma: a retrospective study. about 92 cases]

Sclerodermas are rare affections which can be located or generalized Localized form is the most frequent. The purpose of this study was to describe epidemiologic, clinics, biological, immunological, therapeutic, evolutionary characteristics of the localized scleroderma through a personal series and the data of the literature We have performed a retrospective study on all patients followed in the department of dermatology of the Hospital Charles Nicole during 14]ears period. Our study was about 92 cases of localized scleroderma [73 were females and 19 males]. The mean age was 35 years [between 2 and 72 years]. The majority of localised sclerodermas [66 2%of the cases] appeared before 40 years with a maximum of frequency between 10 and 30 years [41,6%]. Only 11.9%of the cases were observed before 10 years. They were 51 cases [55%] of morphea, 35 cases [38%] of scleroderma in bands including 32 linear scleroderma and 3 scleroderma en coup de sabre, 5 cases [5,5%] of generalized morphea and 1 case [0,15%] of deep morphea. Average therapeutic was specified among 63 patients [87%], and the evolution could be appreciated among 45 patients. The epidemiologic data observed in our series are comparable with those reported in the literature. Therapeutic difficulties and risks of functional after-effects, particular in scleroderma in bands, remain the principal concern for all the authors

[Bullosis diabeticorum: ten cases report]

Bullosis diabeticorum is a rare characteristic complication of diabetes mellitus; it affects 0.5%of diabetics. Bullosis diabeticorum is a manifestation of complicate and longstanding diabetes mellitus. Of our study was to describe particularities of diabetes in patients suffering of this disease. We have led a retrospective study covering a 5 year-period [January 2001-December 2007] in the dermatology department of the Charles Nicolle's hospital in Tunisia. We selected for this study all cases of bullosis diabeticorum. During the studied period, 10 cases have been collected. They were in all cases about complicate and long-standing diabetes. Bullosis diabeticorum has a favourable outcome in all cases with symptomatic treatment. The different cases of bullosis diabeticorum reported in our series were associated to complicate diabetes mellitus what lets suggest that vascular deteriorations led to cutaneous fragility responsible for the skin cleavage

[What is new in the treatment of vitiligo]

Vitiligo is a frequent hypomelanosis that affects 1% of the world population, and 0,95% of the Tunisian population. The objective of our study is to describe through a recent review of the literature, the different therapeutic modalities, now used in vitiligo. We have used a clinical approach to guide therapeutic indications. We have performed a review of the articles, dealing with the treatment of vitiligo and published during the 10 previous years. We have used a Medline research with these key-words: "vitiligo and treatment". Randomized studies were privileged and 29 articles were analysed. We have initially presented all validated therapeutic means now used in vitiligo. We have then proposed, according to this recent review of the literature, clinical indications according to vitiligo type, extension of lesions and if vitiligo involves adults or children. We dispose of multiple chemical, physical and surgical treatments of vitiligo. Vitiligo with partial melanocyte defect can be treated especially by the different modalities of phototherapy [PUVA therapy, PUVASOL, UVB therapy TL01, Laser excimer]. Surgical treatments were also described, with there principal indications. Ethiopathgenic treatments [local steroids, Tacrolimus, Calcipotriol, Vitix] were especially indicated in vitiligo with complete epidermic and follicular achromy. Finally, different therapeutic associadons were reported in the litterature, showing synergic effect of some treatments. Phototherapy remains the best treatment of vitiligo type I. In vitiligo type II and III, ethiopathogenic treatments may be efficient, alone or associated with phototherapy

[Epidemiologic study of cutaneous cancers in aged persons]

The aging of the population in the developed world is an accepted fact. Consequently, the number of aged patients with cutaneous cancer will increase in coming years. The objective was to determine the nature of skin cancer occurring in elderly patients. We retrospectively assessed all patients of 65 years of age and over, with histologically documented skin cancer, in the department of Dermatology of Charles Nicolle hospital of Tunis between 2000 and 2005. We studied sex, age and the type of tumours. 246patients aged 65 years and over and presenting cutaneous cancers were collected. They represented 57.34% of all cutaneous cancers. The average age was 73 years with a majority [91.46%] between 70 and 85 years. Sex-ratio M/F was 1, 82. Basal cell carcinoma [BCC] represented 68.2% of all cutaneous cancers in aged persons and 53.84% of all BCC independently of age. Squamous cell carcinoma [SCC] represented 23.5% of all cutaneous cancers in aged persons and 67.44% of all SCC independently of age. Eight cases [3.25%] of melanomas in aged persons were collected, representing 61.53% of the 13 cases of melanoma during these 5 previous years, independently of age. More than half of the collected cutaneous cancers during these 5 previous years have occurred in aged persons with a majority between the ages of 70 and 85 years. This is explained by a higher life expectancy in Tunisia. Through this study we conclude that the geriatric patient is at a high risk of developing cutaneous neoplasms especially carcinomas

[Systemic corticosteroids and their place in the management of haemorrhagic erysipelas]

Haemorrhagic erysipelas is a recently described clinical condition. Our aim is to study the clinical and evolutive particularities of haemorrhagic erysipelas treated with adjuvant corticotherapy. It's a retrospective study of 6 cases of erysipelas of the lower limbs with serious local signs [purpura, bullae, petechia]. Surgical examination as well as evaluation of muscular enzymes blood level were achieved in all cases. Adequate antibiotherapy and rapidly degressive systemic corticosteroids [0.5mg/Kg daily] were prescribed. Fever, pain and cutaneous signs regressed rapidly. Haemorrhagic erysipelas is different from common erysipelas by the presence of serious local signs [bullae, purpura], by its bad response to adequate antibiotics and by its response to systemic steroids

Multiple autoimmune syndrome in a patient with pemphigus vulgaris a new combination

The occurrence in the same patient of three or more autoimmune diseases defines multiple autoimmune syndrome [MAS]. Various autoimmune dermatoses, especially pemphigus, have been described in association with systemic autoimmune diseases as component of MAS. The aim of our study is to describe MAS with a new combination in a 55-year-old woman having a pemphigus vulgaris, associated with three other autoimmune diseases. A 55-year-old woman presented with multiple oral erosions of one year and blistering over the trunk and limbs of 15 days. Diagnosis of pemphigus vulgaris was confirmed by histology and direct immunofluorescence on cutaneous biopsy. The patient was started on oral prednisone of 1.25 mg/Kg/day with which the lesions subsided gradually. On day 32 of prednisone, she developed jaundice and purpura. Biology showed an exacerbation of a previous anaemia with thrombocytopenia and elevation of serum aminotransferase, consisting in the diagnosis of autoimmune haemolytic anaemia, autoimmune thrombocytopenia and autoimmune hepatitis. After 40 days of oral steroids [1.25mg/Kg/day], cutaneous lesions, purpura and jaundice had completely resolved. Oral steroids were progressively diminished. The patient was seen after a two-year follow-up period without any skin lesions. Anaemia had improved and there was normal serum aminotransferase. Our patient presented a combination of four autoimmune diseases, i.e. pemphigus, autoimmune haemolytic anaemia, autoimmune thrombocytopenia and autoimmune hepatitis consisting in the diagnosis of type II multiple autoimmune syndrome

[Primitive thyroid lymphoma: about 3 casese]

Primary thyroid lymphoma is a rare disease that often develops on a preexisting Hashimoto's thyroiditis. It is diagnosed because of a rapid growth of a goiter associated occasionally with signs of local compression. We report 3 cases of primitive thyroid lymphoma and we discuss its particular clinical aspects and the therapeutic modalities of this entity