[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

[ case of pyomyositis tuberculosis]

Pyomyositis is a muscular infection that is frequently due to commonplace bacteria particularly in immunocompetent patients. However, infections with specific germs can arise even without preliminary risk factors. We report the case of a young non-immunosuppressed patient, who has a sub acute painful tumefaction of a thigh without infectious signs. The clinical examination was in favour of thigh collection. The MRI confirmed this hypothesis and showed an associated osteo-arthritis of the knee. The pus microbiological examination was postitive for Mycobacterium tuberculosis. She favourably evolved under antituberculous treatment and surgical drainage of the collection. As tuberculosis is endemic in our country, we should always consider this diagnosis even in young patients without predisposing factors

[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

Tuberculosis of the thyroid: case report

Thyroid is a rare localization of tuberculosis. The clinical course of the disease may resemble toxic goiter or acute thyroiditis or may follow a subacute or chronic pattern without specific symptomatology. We report the case of a 37 year-old woman referred to the hospital with a diagnosis of goiter without clinical signs of tuberculosis. The diagnosis was established after total thyroidectomy and histological exam. Six-month treatment with antituberculous drugs was administered with a good outcome

[Osteosynthesis of thalamic fractures of the calcaneum about 42 cases]

The displaced thalamic calcaneal fractures involve the functional prognosis of the ankle and foot. The purpose of our study is to defend the surgical treatment of these fractures. We report a continuous and retrospective serie of 42 displaced and isolated fractures treated by open reduction bone graft and osteosynthesis by little plate In a more 3 years review based on SOFCOT criteria functional results are considered excellent and good for 69 per cent of the cases We had restored and maintained the Boehler Angle for 90%of fractures with a no significatively mean loss of 4.33°, Astragalo thalamic congruency is good for 85%of cases. Late complications were dominated by arthrosis of the ankle [12%]. For the indications, we believe that all displaced thalamic fractures of the calcaneum must be operated whatever the radiologic stage. The only contra-indications that must be discussed are the old age, the skin status and arterial pathology

[About two cases of highly probable transfusion induced malaria]

Indigeneous malaria has not been seen in Tunisia since 1979. However blood transfusion has remained a cause of malaria transmission in our country. The last Tunisian transfusion induced malaria was diagnosed in 1985 We report two cases of malaria in two transfused patients documented in our laboratory in November 2003. The first case [patient 1] consisted of a Plasmodium falciparum malaria in a bone marrow transplanted patient; the second case [patient 2] was a Plasmodium malaria malaria, following blood transfusion for stomach surgery. Favourable outcome was obtained under intravenous quinine in patient 1, and oral chloroquine in patient 2. In both cases the relation between transfusion and malaria was not obvious. However, anamnesis showed a donor at risk [African origin] in patient 1, whereas the donor could not be identified at all in patient 2. We concluded that systematic screening of donors at risk would be the best way to prevent transfusion induced malaria in Tunisia

[Isosporosis in AIDS, about five Tunisian cases]

Isosporosis is a digestive parasitosis that occurs on a sporadic basis in our country. It is caused by a protozoan of coccidia class: Isospora belli. Between the years 2000 and 2004, five cases of isosporosis were diagnosed in our laboratory in five AIDS patients. Its prevalence among tunisian patients suffering from Human Iminunodeficiency Virus [HIV] infection in our series is about 1.41%. Main clinical manifestations consisted of acute diarrhea, with malabsorption syndrome in one case. Medical management based on specific antibiotics [sulfamethoxazole-trimethoprime], is efficient in avoiding recurrent episodes. However, recurrency remain frequent as long as immunity remains compromised