[Generalized pustular psoriasis activated by Klebsiella pneumoniae septicaemia]

Generalized pustular psoriasis is a severe form of psoriasis. The pustular dermatosis complicates a known psoriasis frequently after a medicinal taking or infection. It exceptionally inaugurates the psoriatic disease. We report a case of generalized pustular psoriasis triggered by Klebsiella pneumoniae septicaemia and discuss the characteristics of this association. A 43-year-old man, was hospitalized for a profuse pustular eruption evolving for one week with altered general state, fever and liquid diarrhea. The patient ate a tuna sandwich 48 hours prior to the onset of symptoms. The biology showed a hyperleucocytosis, elevated C Reactive Protein and hepatic cytolysis. The skin histology demonstrated a pustular psoriasis. Three blood samples, a coproculture and a catheter culture showed Klebsiella pneumoniae. The patient was treated with antibiotics. The pustular psoriasis was treated by acitretin. The evolution was gradually favourable. Generalized pustular psoriasis is a rare and severe affection. Its prognosis is mainly conditioned by infectious complications

[Psoriasis indicative of HIV infection progress to aids]

Psoriasis is a chronic inflammatory dermatosis which can appear before HIV infection in a patient with personal or family histories of psoriasis or which can be triggered by the HIV infection in a previously unaffected subject. The psoriasis with HIV is often more severe and refractory to classic psoriasis treatments. We report a case of psoriasis that revealed an HIV infection at the AIDS stage, and shall discuss the clinical and therapeutic characteristics of this association. A 40-year-old female has presented with a non pruriginous erythemato-squamous face and scalp eruption with palomplantar keratoderma and onychodystrophy of all toe nails evolving for one ear. On physical examination, an oral candidosis and chronic diarrhea were also noted. The diagnosis of common psoriasis was evoked and the investigations had revealed a lymphopenia at 610/mm[3]. The HIV serology was positive with CD4 at 31/mm[3] and viral load at 31,000 copies/ ml. A chest radiography had shown an apical left opacity due to pulmonary tuberculosis. In few days, the psoriasis extended to the whole integument. The patient was treated by antiretroviral therapy, antituberculosis drugs and local corticosteroids and ointments for her psoriasis. The evolution was quickly favourable. The recent psoriasis developed in an unaffected subject or the exacerbation of a former psoriasis can be associated with immune-suppression. HIV serology is required in such cases

Current epidemiological, clinical and parasitological data concerning cutaneous lesishmaniasis in Tunisia

In order to update the geographical distribution of the three noso-geographical of cutaneous leishmaniasis [CL] occurring in Tunisia, namely the sporadic [SLCL zoonotic [ZCL] and chronic [CCL] forms, and to review their main pattern, a involving 244 cases, was carried out. Most of patients were infected in the Central and Southern parts of the country 74.2% and suffered of ZCL in 64.8% of cases. The three forms were registered in zones considered so far as preserved thus confirming their geographical spread. Sexes were equally affected [sex ratio: 1.02]. The patients were predominantly children and young] adults aged 24.6 years on average. ZCL lesions were mainly multiples [54.1%] localised in the limbs [81.5%] while those of SCL were rather isolated [91%, p<001] and affected the face [84.3%, p<0,00l]. Two clinical presentations prevailed: the classical ulcerous presentation with scabs in ZCL [72%] and the erythematous presentation in SCL [55,9%, p=0.002]. A negative correlation was found between the number and duration of the lesions on presentation [r=0, 22; p<0,00l]. The iso-enzymatic identification of 105 isolated strains confirmed that L. major was the most prevalent species [60.9%] followed by L. infantum [27.6%] and L. killicki [11.4%]. Within L. infantum complex, zymodeme MON-24 was prevailing [75,9%]. CL remains an emergent disease in Tunisia with an incidence and a geographicol spread continuously on the increase. Recent environmental changes, auspicious to Phlebotomine vectors and rodents reservoirs, had probably contributed to that situation

[Singular etiology of inherited aplastlc anemia: a case report of congenital dyskeratosis]

Congenital Dyskeratosis [CD] is a severe inherited disease characterised by a triad of clinical manifestations including abnormal skin pigmentation, nail dystrophy and mucosal leucoplakia. Other clinical manifestations including lung fibrosis and liver cirrhosis worsen the prognosis. Bone marrow hypoplasia is frequently reported, 50 per cent of patients develop pancytopenia before the age of 10 years. We report here the first Tunisian case of DC diagnosed in paediatric age and revealed by a severe bone marrow failure by the age of ten years. The classic triad appeared in the first decade, epiphora, blepharitis, teeth abnormalities and a single kidney were also noted. Androgen therapy stabilised peripheral cytopenia and, decreased the need of red blood cell transfusion

[Familial psoriasis: descriptive report of 9 families]

Psoriasis is a chronic inflammatory skin disease. The familial nature of psoriasis has long been recognized. Our study was to describe the epidemiological, clinical and genetic features of familial psoriasis. Through a prospective study we investigated during a study period of 1 year [2006-2007] 9 Tunisian unrelated multiplex families. Patients with psoriasis and their available family members were examined by the same dermatologist. Thirty nine individual presented psoriasis [25 men and 4 women], with a mean age at onset about 19.8 years. With the systematic exam of member's family we discover 11 cases of unknown psoriasis. The common form of psoriasis was the preponderant one [37 cases]. The nails, the scalp, the mucous membranes were involved respectively in 21, 12 and 13 cases. The psoriasis was severe in 11 cases. Through this study we find similar epidemiological and clinical features of those reported previously. The intra and inter-familial variability was evident in our patients

[Staphylococcus aureus skin infections: a hospital study]

Staphylococcus skin infections [SSI] are common. The emergence methicillin-resistant Staphylococcus aureus [MRSM is a growing concern. our study was to describe the epidemiological, clinical and bacteriological features of SSI in a hospital department. This was a prospective study performed in the Dermatology and Bacteriology department of the La Rabta Hospital during a period of three months [February-April 2008, Were included all cases presenting with a primary SSI. For each patient wee collected epidemiological, clinical, bacteriological and therapeutic features. Twenty-five patients were included in the study concerning 15 men and 10 women, with a mean age of 47 years. Clinical exam revealed a unique lesion in 52%of cases. The abscess was the predominant clinical form [40%]. The bacteriological study isolated a Staphylococcus aureus in the lesion in 40%of cases and in the other sites of staphylococcus portage in 24%of cases. 32%of patients had MRSA. Dermatologists are increasingly faced with cutaneous infections caused by MRSA. Bacterial samples should be taken routinely and probabilistic antibiotic therapy for MRSA instituted in severe infections

[Prevalence of celiac disease in patients with type 1 diabetes mellitus]

The aim of our study was to determine the prevalence of celiac disease in patients with type 1 diabetes mellitus. Between january 2004 and december 2005, 72 patients with type I diabetes mellitus and having pseudo ulcerous dyspepsia were included in this prospective study. Upper gastrointestinal endoscopy with proximal intestinal biopsies was performed in all patients. Patients with villous atrophy were tested for anti-gliadine antibodies, anti-endomysium antibodies and for anti-human tissue transglutaminase antibodies. Villous atrophy was observed in three patients [4, 1%]. It was subtotal in two cases and total in one case. Anti-gliadine antibodies, anti-endomysium antibodies and anti-human tissue transglutaminase antibodies were positive to three patients. The prevalence of celiac disease in patients with type 1 diabetes mellitus is high [4, 1%]. Early screening of celiac disease must be recommended to this diabetic population

[ epidemio clinical of lichen sclerosus about 31 cases]

Lichen sclerosus is a chronic inflammatory mucocutaneous disease. Through a retrospective study of all patients with Lichen sclerosus followed between 1997 and 2005 at the dermatology department of La Rabta hospital, we outline the epidemio-clinical aspects of this entity. There were 29 female and two male. Two patients were child. The mean age at the occurrence of adult lichen sclerosus was 51, 5 years. The site of the lesions was perineum and genital in 26 cases [one male and 25 female]. Extragenital involvement was present in 10 patients. All patients underwent topical corticosteroid therapy. Architectural changes of vulva were noted in 7 cases. An epidermoid carcinoma occurred in five patients. The male Lichen sclerosus seem to be rare in our study. It is probably explained by the protective role of the circumcision which is practised in all male children in our country. In our study, the risk of malignant transformation of genital Lichen sclerosus is estimated at 19, 2%. It is lightly more than mentioned in the literature. This may be related to the cofactor role of l-IPV and to an insufficient treatment adherence

[Erythema nodosum: profile in a Tunisian teaching hospital]

Background: Erythema nodosum [EN] is the most frequent acute nodular hypodermatitis. Etiologies of EN are varied although a similar clinical presentation

The aim of our study is to establish epidemio-clinical characteristics of EN in 103 patients

Methods: [62 in care [January 1980-december 2005] were seen on the dermatology unit of the Rabta hospital. We have only included patients that had done: blood count, chest X-Ray, ASLO, tuberculin intradermoreaction, transaminase, inflammation marker

Results: We had 86 women and 17 men with a mean age of 36,5 years. Lesions were located in lower limbs in 88 cases. The man etiologies were: post streptococcal infections [42 cases], tuberculosis [8 cases], Crohn disease [8 cases], Behcet disease [7 cases] and sarcoidosis [5 cases]. EN was idiopathic in 23 patients. The most common provoking agent of EN varies from a country to another and even in the same country from a study to another. In Tunisia, post streptococcal infection and Behcet disease still frequent etiologies for EN, sarcoidosis and inflammatory colites are more and more found unlike tuberculosis which is less incriminated than before. In case of EN it is reasonable to begin etiological enquiry by common causes

[Prevalence of helicobacter pylori infection in ulcerous duodenal disease of West center of Tunisia]

Determine the prevalence of helicobacter pylori infection in patients native of the west center of tunisia and having ulcerous duodenal disease: Descriptive study including 106 patients affected by no complicated duodenal ulcer having had one gastroscopy in the internal medecine department at Sidi Bouzid Hospital. Helicobacter pylori infection is defined by visualization of bacterium on gastric takings. the mean age of our patients was of 45.8 years with a light male predominance. Prevalence of helicobacter pylori infection was 97.1%. Antral location of the infection was observed in 56.6% of cases. Fundus and antral location of the infection was observed in the remaining cases. All patients have antral chronicle gastritis. In our study, the prevalence of helicobacter pylori in patients having duodenal ulcer is very high, justifying attitude therapeutics anti helicobacter pylori without systematic search of bacterium

[Superficial fungal infections. Epidemiology, clinical and mycological study over years period]

The object of our study is to release the epidemiological, clinical and mycological characteristics of superficial fugal infections. A retrospective study was carried out during three years [1996-1998]. Direct microscopy was positive in 86% cases, the culture in 62% cases. Trichophyton rubrum accounts for 85% of the dermatophytic flora. The superficial fugal infections account for 15% of the reasons for consultation in our service. They would touch according to data's of literature 2 to 13% of the general population. Trichophyton rubrum in accordance with the various series published, is the fungi most frequently insulated with variable rates between 46 and 82% of the superficial fugal infections. Any time, Candida albicans is prevalent on the level of the hands

[Root resorption in orthodontic]

Root resorption is a result of orthodontic treatment, this resorption is in relation with intensity and movement applied on teeth Our experimental work demonstrates that bone loss are more evident in histology than in radiology after application of forces with 50 G/F intensity during 45 days. Main affected area was the apical third

[Dermatofibrosarcoma protuberans about 18 cases]

Dermatofibrosarcoma protuberans [DFSP] is a rare mesenchyma skin tumor. It is characterized by a slow growth with a high rate of recurrence but limited potential for metastasis. We report the result of a retrospective study of 18 cases of DFSP collected over 16 years in the dermatology department of La Rabta Hospital. The mean age was 32 years with a sex ratio of 1.57. The site of predilection was the trunk [77.5%]. Histological features were typical in all cases with positivity for CD34 in 14 cases. Treatment was surgical in 13 cases. DFSP is a tumor of intermediate malignancy, which can have aggressive course. This tumor is best treated with surgery in which large excision are necessary to reduce the risk of recurrence

[Importance of amastigote forms morphology to differentiate Leishmania infantum and Leishmania major species]

The microscopic study of the dermal smears of 62 cases of cutaneous leishmaniose, 27 infected by Leishmania [L.] infantum and 35 by L. major, showed that the amastigotes of L. infantum are meaningfully smaller [p < 0.001]. This criteria is a simple pary alternative to distinguish these 2 species which have completely different epidemiology, recovery delay and prophylactic dispositions