[Retrospective study of cutaneous leishmaniasis in the district hospital of Am Timan, Chad]. / Étude rétrospective de la leishmaniose cutanée à l'hôpital de district d'Am Timan, Tchad.

Cutaneous leishmaniasis is not included in the statistical yearbook of Health of the Ministry of Public Health. The aim of our study was to describe the epidemiological profile of cases of cutaneous leishmaniasis attended at the District Hospital of Am Timan in order to assess the importance and the prevalence of this neglected disease. This is a retrospective study of cases reported in the records of the Laboratory of the Hospital District of Am Timan between January 2008 and December 2012. It allowed the identification of 680 clinical cases. Direct microscopic diagnosis was positive in 580 cases (85%). The number of cases has been increasing from 2008 to 2010 (2008 = 80 cases, 123 cases in 2009; 2010 = 198 cases) before decreasing during the following year (2011 = 137 cases and in 2012 = 42 cases). The months of strong incidence of the cases were June, July, August and September. The M/F sex-ratio was 1.7.

[Verapamil-induced linear IgA disease mimicking toxic epidermal necrolysis]. / Dermatose à IgA linéaire induite par le vérapamil : présentation inhabituelle à type de nécrolyse épidermique toxique.

BACKGROUND: Linear IgA bullous dermatosis is a rare auto-immune bullous dermatitis characterized by linear IgA deposits in the basal membrane zone. Clinical diagnosis may be difficult due to the various clinical presentations mimicking bullous pemphigoid, pemphigus, erythema multiforme or toxic epidermal necrolysis. Linear IgA may be idiopathic or due to drugs, particularly vancomycin. PATIENTS AND METHODS: We describe a 91-year-old woman treated with verapamil for coronary disease who developed an eruption presenting as a toxic epidermal necrolysis, although the diagnosis was amended after direct immunofluorescence revealed IgA deposits in the basal membrane zone. DISCUSSION: Ours appears to be the first reported case of verapamil-induced linear IgA bullous dermatosis.

[Erythema multiforme majus and Chlamydia pneumoniae infection]. / Erythème polymorphe majeur et infection à Chlamydia pneumoniae.

BACKGROUND: Erythema multiforme majus of infectious origin is an acute eruptive syndrome seen more commonly in young subjects and characterised by an appearance of round target lesions. In most cases, it is associated with infection involving Herpes simplex virus or Mycoplasma pneumoniae. We report an original case of erythema multiforme majus subsequent to infection with Chlamydia pneumoniae. CASE REPORT: An 18 year-old man was hospitalised for management of generalised skin rash comprising lesions in rings, associated with bullous and post-bullous lesions, chiefly in the oral (preventing eating) and genital areas in a setting of febrile cough. Various bacterial agents (Mycoplasma pneumoniae, Chlamydia pneumoniae) and viral agents were suspected, but serological testing for Chlamydia pneumoniae alone was positive with IgM of 128 IU and IgG of 64 IU. The outcome was favourable within several days following administration of symptomatic treatment (rehydration, mouthwashes, etc.) and aetiological treatment (acyclovir: 30 mg/kg/d, ofloxacine: 400 mg/d). At D15, serologic tests for Mycoplasma pneumoniae continued to be negative. Anti-Chlamydia pneumoniae IgM and IgG were 256 IU. At D30, IgM was 128 IU while IgG remained at 256 IU. DISCUSSION: The existence of a systematic skin rash comprising typical target lesions and mucosal lesions in the oral and genital areas suggested to us a diagnosis of erythema multiforme majus. Screening for the agents generally responsible was negative and drug-induced rash was ruled out. Serological tests for Chlamydia pneumoniae were positive at various times, resulting in diagnosis of erythema multiforme majus secondary to infection with Chlamydia pneumoniae. Following demonstration of the presence of Chlamydia pneumoniae using reliable methods and the elimination of other causes of erythema multiforme majus, dermatologists should opt for this aetiology in order to optimise treatment.

[Mycosis fungoides presenting as annular erythema]. / Mycosis fongoïde à type d'érythème annulaire centrifuge.

INTRODUCTION: Mycosis fungoides is a lymphoma, the classical clinical form of which involves erythematosquamous lesions. However, it can present various atypical aspects: hyper pigmentation or hypo pigmentation, suggestive of pyoderma gangrenosum or ichtyosis. We report a case of mycosis fungoides, unusual in its presentation in the form of centrifugal annular erythema. OBSERVATION: A 78 year-old man had developed a parapsoriasis in plaques for more than 20 years. In May 2002 he consulted because of the recent infiltration of one of the plaques, without concomitant pruritus. The clinical examination revealed 3 lesions of the popliteal groove of the right groin and the left cheek suggestive of centrifugal annular erythema. Histology, revealing Pautrier microabscesses, was compatible with the diagnosis of mycosis fungoides. Evolution was marked by the spontaneous regression of the plaque on the face and remission of the other two plaques after local treatment with chloromethin and topical corticosteroids. Nevertheless, new plaques appeared despite continued treatment, combined with PUVA therapy sessions. DISCUSSION: When searching the literature, we only found one other case of mycosis fungoides, the clinical aspect of which was a centrifugal annular erythema, but in which the histological examination confirmed the diagnosis of mycosis fungoides. Our case report is also unusual in the clinical regression of the lesion on the face, without treatment; this has only been reported in two cases. Mycosis fungoides can appear in various clinical forms. The centrifugal annular erythema form is rare, but this diagnosis should be evoked.