[Pulmonary tuberculosis associated with cutaneous and mediastinal sarcoidosis - a case report]

The association of sarcoidosis and tuberculosis is rare and its differentiation is sometimes very difficult. We report a case of a 49 years woman presenting insidious erythematous and nodular lesions of the face that histologically revealed non caseating granulomas of the dermis and diagnosed as cutaneous sarcoidosis. We have concomitantly diagnosed evolutive pulmonary and nasal tuberculosis treated during 2 months with isoniazid, rifampicin, pyrazinamid and streptomycin and for 6 months with isoniazid and rifampicin. The evolution of nasal obstruction was favorable and pulmonary bacteriologic examination was negative at two months treatment but mediastinal adenopathy and cutaneous lesions were unchanged. The patient was treated with Isotretinoin 60 mg daily during 6 months inducing regression of cutaneous lesions but adenopathy still unchanged. At 8-months follow-up the patient is still free of cutaneous recurrence. In our patient cutaneous sarcoidosis appeared concomitantly with evolutive tuberculosis raising further questions about the role of mycobacterium in causing this granulomatous disorder. In addition cutaneous nodules responded to isotretinoin suggesting that this drug can be useful in cutaneous sarcoidosis

[Management of severe psoriasis: about 50 cases]

Background: With its varied clinical presentation, psoriasis is actually considered as a public health care problem. Severe psoriasis remains difficult to treat

Methods: Our study was retrospective involving 50 patient with severe psoriasis treated in the dermatology unit of military hospital of Tunis from January 1990 to December 2003

Aim of our study was to evaluate actual different therapeutic attitudes and new treatments in case of severe psoriasis

Results: During the 14 years studied the frequency of severe psoriasis was about 19,5%. Extended psoriasis was noticed on 64% of the patients. Arthropatic psoriasis was found on only 6% of the patients. Erythrodermic psoriasis, pustular psoriasis and palmoplantar psoriatic keratoderma were equally noticed in 10% of the patients. PUVA-therapy was firstly prescribed on 96,6% of the patient with extended psoriasis, bettering was noticed on 71% of all them during the 3 first cures. From the 20 patients that have received acitretin, 65% have noticed improvement. Methotrexate and RE-PUVA was secondarily used [only for the cases of psoriasic arthritis amd methotrexate] on respectively 18% and 10% of the patients. All our patients reported worsening on them quality of life

Conclusion: Cyclosporin is more and more used initially in cases of rebellious psoriasis. Actually therapeutic hope leans on biological therapies

Pneumatosis cystoides intestinalis in a Saudi patient

Pneumatosis cystoides intestinalis is a rare condition. This is the first case reported in a Saudi patient The patient had IDDM, hypertension and previous ischaemic colitis. He presented with intestinal obstruction and on exploration a segment of the small bowel had to be resected due to extensive adhesions. Pathological examination showed multiple gas filled cystic spaces in the submucosa and serosa. Microscopic examination revealed that these cysts were 3-7 cm in diameter and were focally lined by flattened cells and filled with lymph like fluid. The surrounding tissues showed inflammatory cell infiltrate and were congested with blood vessels

Mucin secreting [Goblet cell] endobronchial polypoid adenocarcinoma of the lung with osseous metaplasia

Pulmonary endobronchial adenocarcinoma is a rare lung tumor. An unusual case staged as T2N1 MO with poor subsequent prognosis is described here, showing microscopically prominent mucinous goblet cell differentiation and benign osseous metaplasia. The former feature has only been rarely encountered, and the latter change is reported for the first time in the literature