Androgenetic alopecia: Traditional cardiovascular risk factors, metabolic syndrome, and component traits among Nigerian adults.

Background: Androgenetic alopecia (AGA) has been linked to cardiovascular diseases (CVDs) and metabolic syndrome (MetS). Works on AGA, cardiovascular risk factors (CVRFs) and MetS are rare among Nigerians. Aim: This study set out to determine the relationship among CVRFs, MetS, and AGA. Subjects and Methods: This is a cross-sectional study done among adults who were 18 years and above in selected communities in Ogbomoso on 260 consenting AGA participants as well as 260 age controls without AGA. They were matched for age and sex using a multistage sampling method. Anthropometric measurements, fasting blood glucose, and lipid profile samples were collected. MetS was diagnosed using International Diabetes Federation criteria. Data were analyzed using IBM SPSS version 20. Ethical approval was gotten before commencement of the study (LTH/OGB/EC/2017/162). Result: Metabolic syndrome in AGA was higher than in controls (8.08% vs. 7.69%, p = 0.742). AGA was significantly associated with elevated mean systolic blood pressure (SBP) (p = 0.008), low High Density Lipoprotein (HDL-c) (p < 0.001), alcohol intake (p < 0.001), dyslipidaemia (p = 0.002), and sedentary lifestyle (p = 0.010). The correlates of AGA severity in male and female gender are age (p < 0.001 and 0.009 respectively), SBP (p = 0.024) and abdominal obesity (p = 0.027) in male gender. Conclusion: AGA in Nigerians is associated with dyslipidaemia, alcohol intake, and sedentary lifestyle. AGA severity is related to age, higher mean SBP, abdominal obesity and low HDL-c in male and age, and Body mass index in females. Nigerians with AGA should be screened for dyslipidaemia and counseled against the use of alcohol and sedentary lifestyle.

Napkin Dermatitis: Skin Hydration Levels and Skin Care Practices amongst Children at Urban Comprehensive Health Centre, Ile-Ife, Nigeria.

INTRODUCTION: Napkin Dermatitis (ND) means skin inflammation occurring within the napkin area. Skin care practices and skin hydration levels (SHL) are parameters of interest in the pathogenesis of ND. AIM AND OBJECTIVES: To compare napkin area skin care practices and levels of skin hydration in children with ND and those without ND and to determine the predictors of ND in children. METHODS: This was a case-control study of 60 participants with ND and 60 age and sex matched controls without ND, aged below 12 months that used napkins. Information on napkin area skin care practices were obtained from parents and diagnosis of ND was made clinically. Skin hydration levels were measured using a Corneometer®. RESULTS: The median age of children was 16 ± 17.1 weeks (range 2-48 weeks). Controls were more likely to use appropriate barrier agents compared with participants with ND (71.7% vs. 33.3%; p<0.001). There was no significant difference in the mean SHL ± SD of participants with ND and controls on the non-lesional (buttock) area (42.00 ± 19.71 vs. 43.46 ± 21.68; t = - 0.384, p= 0.702). Controls who always used a barrier agent were 83% less likely to have ND than those who did sometimes and those who never used a barrier agent (OR: 0.168, CI: 0.064-0.445, p< 0.001). CONCLUSION: Consistent use of an appropriate barrier agent could be protective against ND.

INTRODUCTION: La dermatite de la serviette (DN) désigne une inflammation cutanée survenant dans la zone de la serviette. Les pratiques de soins de la peau et les niveaux d'hydratation de la peau (SHL) sont des paramètres d'intérêt dans la pathogenèse de la DN. BUT ET OBJECTIFS: Comparer les pratiques de soins de la peau de la zone de la serviette et les niveaux d'hydratation de la peau chez les enfants atteints de MN et ceux qui ne le sont pas, et déterminer les facteurs prédictifs de la MN chez les enfants. MÉTHODES: Il s'agit d'une étude cas-témoins portant sur 60 participants atteints de MN et 60 témoins non atteints de MN, appariés selon l'âge et le sexe, âgés de moins de 12 mois et utilisant des serviettes. Les parents ont fourni des informations sur les pratiques de soins de la peau sur les serviettes et le diagnostic de la MN a été posé cliniquement. Les niveaux d'hydratation de la peau ont été mesurés à l'aide d'un Cornéomètre®. RÉSULTATS: L'âge médian des enfants était de 16 ± 17,1 semaines (intervalle 2-48 semaines). Les témoins étaient plus susceptibles d'utiliser des agents de barrière appropriés que les participants atteints de MN (71,7 % contre 33,3 % ; p<0,001). Il n'y a pas de différence significative entre la moyenne des SHL ± SD des participants atteints de MN et des témoins sur la zone non-lésionnelle (fesse) (42,00 ±19,71 vs. 43,46 ± 21,68 ; t= -0,384, p= 0,702). Les témoins qui utilisaient toujours un agent barrière étaient 83 % moins susceptibles de souffrir de MN que ceux qui le faisaient parfois et ceux qui n'utilisaient jamais d'agent barrière (OR : 0,168, IC : 0,064 - 0,445, p< 0,001). CONCLUSION: L'utilisation systématique d'un agent barrière approprié pourrait être un facteur de protection contre la MN. Mots clés: Dermatite de la Nappe, Hydratation de la Peau et Soins de la Peau.

Serum Ferritin Levels amongst Individuals with Androgenetic Alopecia in Ile-Ife, Nigeria.

BACKGROUND: Androgenetic alopecia (AGA) is the most common form of alopecia, affecting 50% of the adult population world-wide. The exact mechanisms of this common hair disorder are yet to be fully elucidated. It is believed to be related to high circulating androgen levels in the blood and it is genetically determined. Deficiencies of micronutrients such as iron in the development of AGA have been a subject of debate. OBJECTIVE: This study sought to determine the association between serum ferritin levels and androgenetic alopecia among patients attending the Dermatology clinic at a tertiary health facility in South-Western Nigeria. METHODS: This was a hospital based cross sectional study with a total of 114 participants, which consisted of 57 subjects with AGA and 57 age and sex-matched healthy adults without AGAwho met the inclusion criteria. The diagnosis of AGA was made clinically and with the aid of a Dermatoscope (Wi-Fi Digital Microscope RoHS YPC_X03 V2018, HD Colour CMOS sensor with 50X-1000X magnification and HD resolution 1920x1080P). RESULTS: The mean age of the study participants was 41.68 ± 12.86 years with age ranging from 24 to 80 years. The mean serum ferritin levels among the subjects and control group were 188.65 ±97.92ng/ml and 194.49 ± 76.67ng/ml respectively but this difference was not statistically significant (p = 0.724). However, subjects with premature AGA had a significantly lower serum ferritin level compared to those with adult-onset AGA (p = 0.020). CONCLUSION: Iron deficiency is known to cause quantitative defect in haemoglobin production, limiting the amount of oxygen transported for hair growth and this, in addition to genetic factors, may explain why individuals with premature AGA have a significantly low serum ferritin levels.

CONTEXTE: L'alopécie androgénétique (AGA) est la forme la plus courante d'alopécie, affectant 50% de la population adulte dans le monde. Les mécanismes exacts de ce trouble capillaire commun n'ont pas encore été entièrement élucidés. On pense qu'il est lié à des taux élevés d'androgènes circulants dans le sang et qu'il est génétiquement déterminé. Les carences en micronutriments tels que le fer dans le développement de l'AGA ont fait l'objet de débats. OBJECTIF: Cette étude a cherché à déterminer l'association entre les niveaux de ferritine sérique et l'alopécie androgénétique chez les patients fréquentant la clinique de dermatologie d'un établissement de santé tertiaire du sud-ouest du Nigeria. MÉTHODES: Il s'agissait d'une étude transversale en milieu hospitalier avec un total de 114 participants, dont 57 sujets atteints d'AGA et 57 adultes en bonne santé, appariés selon l'âge et le sexe, sans AGA, qui répondaient aux critères d'inclusion. Le diagnostic de l'AGA a été établi cliniquement et à l'aide d'un dermatoscope (microscope numérique Wi-Fi RoHS YPC_X03 V2018, capteur CMOS couleur HD avec un grossissement de 50X-1000X et une résolution HD 1920x1080P). RÉSULTATS: L'âge moyen des participants à l'étude était de 41,68 ± 12,86 ans avec un âge allant de 24 à 80 ans. Les taux moyens de ferritine sérique chez les sujets et le groupe témoin étaient respectivement de 188,65 ± 97,92ng/ml et 194,49 ± 76,67ng/ml mais cette différence n'était pas statistiquement significative (p = 0,724). Cependant, les sujets atteints d'AGA prématurée avaient un taux de ferritine sérique significativement plus bas que ceux atteints d'AGA à l'âge adulte (p = 0,020). CONCLUSION: La carence en fer est connue pour provoquer un défaut quantitatif dans la production d'hémoglobine, limitant la quantité d'oxygène transportée pour la croissance des cheveux et ceci, en plus des facteurs génétiques, peut expliquer pourquoi les individus atteints d'AGA prématuré ont un taux de ferritine sérique significativement bas. Mots clés: Alopécie androgénétique, chute de cheveux, micronutriments, fer, ferritine, Nigeria.

Keloids in Darkly Pigmented Skin: Clinical Pattern and Presentation at a Tertiary Health Facility, Southwest Nigeria.

BACKGROUND: Keloids are chronic dermal fibro-proliferative disorders resulting from excessive collagen deposition. Although it is commonly seen in the dark skin, it occurs in other races. It is a disfiguring dermatosis whose epidemiology and clinical pattern should be put into proper perspective in an area where it has not been extensively documented. SUBJECTS AND METHOD: A cross-sectional design that included 120 consenting keloids patients was made at the dermatology and plastic surgery clinics of a tertiary hospital over one year. Keloid was diagnosed clinically, risk factors, locations and patterns of affectation were documented. RESULTS: 120 patients with 192 keloids were seen. The mean age of the patients was 36.3±16.0 years with a slight female preponderance (M: F, 1:1.9). The chest was the commonest site 37 (19.3%), then earlobe 27 (14.1%) and face 21(11.0%). The buttock/feet were the least affected areas. Trauma including ear piercing, shaving, lacerations/cuts were the commonest risk factors 108 (56.2%) for keloid. The commonest observed morphological patterns in descending order of occurrence include flat 61 (31.8%), nodular 54 (28.1%) and superficial spreading 51 (26.6%) type. Flat pattern was commonest in breast and chest areas 35 (71.4%), nodular pattern on earlobes 17 (63.0%), face 11 (52.3%), scalp 3 (50.0%), neck 5 (38.5%), and guttate pattern on the face 3 (14.0%) and back 2 (22.0%). The shoulder 5 (50.0%), arms 7 (58.3%) and back 4 (44.4%) had more of the superficial spreading pattern when the morphology/patterns of keloid in these areas were compared. CONCLUSION: Keloids affects predominantly young adults with single anatomical site being the commonest presentation, with the chest mostly affected and the flat pattern commonly observed. The morphological distinction of keloids and location may influence the choice of treatment modality.

CONTEXTE: Les chéloïdes sont des troubles dermiques chroniques fibro-prolifératifs résultant d'un dépôt excessif de collagène résultant d'un dépôt excessif de collagène. Bien qu'elle soit couramment dans les peaux foncées, elle se produit dans d'autres races. Il s'agit d'une dermatose défigurante dermatose dont l'épidémiologie et le profil clinique doivent être mis en perspective dans une région où elle n'a pas été largement documentée. SUJETS ET MÉTHODE: Une étude transversale incluant 120 patients consentants atteints de chéloïdes a été réalisée dans les cliniques de dermatologie et de chirurgie plastique d'un hôpital tertiaire sur une période d'un an. La chéloïde a été diagnostiquée cliniquement, les facteurs de risque, les localisations et les schémas d'affectation ont été documentés. RÉSULTATS: 120 patients présentant 192 chéloïdes ont été examinés. L'âge moyen des patients était de 36,3±16,0 ans avec une légère prépondérance féminine (M : F,1:1.9). La poitrine était le site le plus fréquent 37 (19,3%), puis le lobe de l'oreille 27 (14,1 %) et le visage 21 (11,0 %). Les fesses et les pieds étaient les zones les moins touchées zones les moins touchées. Les traumatismes, y compris le perçage des oreilles, le rasage, les lacérations/coupures, étaient les facteurs de risque les plus courants.les facteurs de risque les plus courants 108 (56,2 %) pour la chéloïde. Les formes morphologiques les plus courantes morphologiques les plus fréquemment observés, par ordre décroissant de fréquence sont le type plat 61 (31,8 %), le type nodulaire 54 (28,1 %) et le type d'extension superficielle 51 (26,6 %). La forme plate était la plus fréquente dans les zones du sein et de la poitrine.35 (71,4 %), le type nodulaire sur le lobe des oreilles 17 (63,0 %), le visage 11 (52,3 %), cuir chevelu 3 (50,0 %), le cou 5 (38,5 %), et le motif en gouttes sur le visage 3 (14,0 %) et le dos 2 (22,0 %). L'épaule 5 (50,0 %), les bras 7 (58,3 %) (58,3 %) et le dos 4 (44,4 %) présentaient davantage de motifs d'étalement superficiel morphologie/profil de la chéloïde dans ces zones. CONCLUSION: Les chéloïdes touchent principalement les jeunes adultes. site anatomique unique est la présentation la plus courante, le thorax étant le plus souvent touché. La poitrine est la plus touchée et le modèle plat est couramment observé. Le site distinction morphologique des chéloïdes et de leur localisation peut influencer le choix de la modalité de traitement. MOTS CLÉS: Chéloïde, Peau foncée, Épidémiologie, Profil Clinique.

The Cutaneous Manifestations of COVID-19: A Review of Emerging Literature.

The initial clinical manifestations of COVID 19 in Wuhan was fever, cough and shortness of breath but early reports in Italy and Spain preceded emerging literature of skin involvement. COVID19 was first reported in December, 2019 and after several observations of cutaneous involvement in patients with the disease there was need to document such in literature. The details of the clinical presentation and the pathophysiological mechanisms of these cutaneous lesions are, however, still poorly understood. This is a review of twenty-four published scientific articles summarizing the various cutaneous features observed by the frontline health care givers involved in the management of patients with Covid-19. Maculopapular exanthem was the most common pattern reported, accounting for 44.4% of skin manifestations. The pseudo-chilblain, urticarial, vesicular, livedoid and Kawasaki-like disease patterns accounted for 18.1%, 17.6%, 12.9%, 5.1% and 1.9% respectively. Anumber of the patients (9.5%) developed skin lesions at the time of diagnosis of Covid-19 or at the onset of Covid-19 respiratory symptoms while 75.1% developed the lesions after the onset of Covid-19 respiratory symptoms or after laboratory diagnosis of the disease had been made. There is no gainsaying that apart from the respiratory and other reported systems, Covid-19 also affects the skin. Clinicians, especially dermatologists, should therefore watch out for the already reported skin lesions and for possible yet to be discovered or reported skin lesions in patients with Covid-19. Dermatologists must bear in mind that patients presenting at skin clinics may actually be infected with Covid-19.

Pattern of paediatric dermatoses at dermatology clinics in Ile-Ife and Ilesha, Nigeria.

BACKGROUND: In developing countries, skin diseases are one of the most common causes of morbidity. AIM: A prospective descriptive study was conducted to determine the pattern of skin diseases in childhood and adolescents presenting to the outpatient dermatology clinics of Obafemi Awolowo University Teaching Hospitals Complex at Ile-Ife and Ilesha, Osun State. METHODS: Patients aged 2 weeks to 19 years attending the clinics between October 2009 and September 2012 were included. RESULTS: A total of 491 dermatoses were recorded in 441 patients. There were 244 (49.6%) males. Dermatophyte infections (17.1%), papular urticaria (6.7%), atopic dermatitis (6.3%), vitiligo (5.3%), acne (4.7%) and viral warts (3.7%) were the most frequent dermatoses. Skin infections and infestations, mostly dermatophyte infections and viral warts, accounted for 57.6% of the skin conditions. Of the non-infectious diseases, papular urticaria and atopic dermatitis were the most common. Dermatophyte infections were the most prevalent in children (25.8%), and acne vulgaris in adolescents (11.8%). CONCLUSION: Skin infections and infestations, mostly dermatophyte infections, were the most prevalent in children, and acne vulgaris in adolescents.

Pattern of dermatoses among inmates of Ilesha Prison, Nigeria.

AIMS AND OBJECTIVES: Dermatoses are common health problems in prisons and environmental conditions influence their prevalence and pattern. Hot and humid environment as obtains in the tropics, stress, and overcrowding are conditions that facilitate development of. The aim of this study was to determine the prevalence and pattern of dermatoses in a prison located in a tropical environment. MATERIALS AND METHODS: The study was done in May-July 2006 in a South-West Nigerian prison. Using a purpose designed questionnaire, information on sex, age, prison status, and number in rooms was obtained and inmates were clinically examined. RESULTS: Inmates studied were 305 (296 males and 9 females). Dermatoses were found in 221 inmates with overall prevalence of 72.5% (221/305). Infectious disorders were seen in 67.9% (150/221) and non-infectious in 32.1% (71/221). The diseases occurred in 72.9% (167/229) of awaiting trial persons and 72.9% (51/70) convicted persons. Overcrowding was more in cells (average sleeping area was 9.5 sq feet). Skin diseases affected 80.3% (61/76) of inmates in cells and 69.9% (160/229) in dormitory rooms.. About 71.2% (94/132) of inmates affected stay in five highly overcrowded dormitory rooms with infectious disorders in 48.5% (64/132). Dermatophyte infections were 34.3% of 332 dermatoses seen, pityriasis versicolor 14.5%, acne vulgaris 12.3%, dandruff 10.5%, 28.4%. A significant relationship was found with overcrowding and place where dermatoses were first noticed. CONCLUSION: Dermatoses are common health problem of prisoners, and prison conditions facilitate these problems.

Breast Fine Needle Aspiration Cytology in a Nigerian Tertiary Hospital

Objectives:Breast disease remains a major public health issue worldwide.It is the most common cancer among Nigerian women.Fine needle aspiration cytology (FNAC) is an important preoperative assessment tool along with clinical and mammography examination in both screen detected and symptomatic breast disease.This study provide opportunity to determining the accuracy of FNAC and factors affecting false negative rate in Obafemi Awolowo University Teaching Hospital complex; Ile-Ife; Osun state Nigeria Method:All patients seen in the breast clinic with lump were sent to the pathology department for FNAC from January 1997 to December 2004.The sociodemographic data; cytology result; final histology result and the clinical staging for breast cancer were analyzed.Results:Eight hundred and sixty-four patients had FNAC during the studied period; however only 632 cases had available final histological report.Of these; 20 (3.2) were male while 612 (96.8) were female; the age ranged from 15 years to 99 years; median of 36.50.We found that absolute sensitivity for malignancy to be 70.8.The false negative rate was 14.9; while the false positive rate was 1.8.The suspicious rate was 9.8while the inadequate rate was 5.4.Conclusion:FNAC remains the least invasive; the most rapid and the most cost effective method to confirm clinical and radiological suspicion of malignancy; however; the test has high false negative rate.We recommend that consultation between pathologists and the clinicians should be facilitated and encouraged to reduce the high false negative. Also; multi-disciplinary audits of difficult case should be part of the work routine

Gastroduodenitis and Helicobacter pylori in Nigerians: histopathological assessment of endoscopic biopsies.

OBJECTIVE: Morphologic changes seen in the endoscopic biopsies are dynamic and could be predictive of more important sequelae of chronic H. pylori gastritis such as gastric carcinoma and lymphoma. The objective of the study was to review the biopsy appearances of endoscopic gastroduodenal biopsies using the updated Sydney System of classification in order to throw some light on the biology of gastroduodenitis. METHODS: A retrospective review of all endoscopic gastroduodenal biopsies received in the department of Morbid Anatomy of Obafemi Awolowo University Teaching Hospitals Complex between 1994 and 2003 was undertaken. Grading of the chronicity, activity, atrophy, H. pylori density and metaplasia were done using the updated Sydney System of classification and grading. RESULTS: A total of 1047 gastric and 47 duodenal biopsies from 1047 patients were reviewed. There was evidence of significant chronic gastritis in 98.1% of the gastric biopsies and in 78.0% of these, H. pylori was the main identifiable aetiological agent. Marked atrophic changes and intestinal metaplasia that are known to predispose to gastric malignances were seen in 4.9% and 9.3% of our cases respectively. Chronic duodenitis was seen in 83% of the duodenal biopsies and in 29.6%, H. pylori was seen on a background of gastric metaplasia. CONCLUSION: The prevalence of H. pylori was high and it was the single most important aetiological factor responsible for the biopsy changes associated with chronic gastroduodenitis.

Selenium and aspirin in people living with HIV and AIDS in Nigeria.

OBJECTIVES: Aspirin and selenium have been shown in vitro and in vivo to inhibit HIV production through inhibition of the transcription factor, the nuclear factor kappa binding (NF-eB). The aim of this study was to examine the efficacy or otherwise of these drugs in people living with HIV and AIDS (PLWAS) in resource limited countries. PATIENTS AND METHODS: Consenting HAART-naive PLWAS with mean CD4 count of 256.8 +/- 67.6 cells/ul were recruited into the study. Pretherapy blood count, serum biochemistry, chest x-ray, urinary glucose and protein and microscopy and culture of both urine and stool were checked in all cases. Each patient was treated for six months and CD4 counts were repeated at the end of the study. Thirty two patients (23 (72%) females and nine (28%) males), aged 22-52 (median = 36) years were recruited. Twenty-three (72%) were randomised into selenium and aspirin (SAM) and nine (28%) into selenium (SM); multivitamin was added to each arm. RESULTS: Eighteen (56.2%) patients completed the study. Sixteen (88.9%) patients are already on HAART since the termination of the study; one absconded and one died of disease progression. Fourteen (43.8%) of the initial 32 patients dropped out (11 (78.6%) were lost to follow-up, two (14.3%) died and one (7.1%) opted for HAART before completing the study). The post-treatment CD4 count was 293.0 +/-102.2 cells/ml, compared to the pre-therapy mean of 256.8 +/- 67.6 cells/ul, an average rise of 36.2 cells/ul, the difference was not statistically significant (p = 0.059). The post-therapy mean weight was significantly higher than the pretherapy weight, 61.6+/-15.2 kg versus 60.0+/-14.3 kg (p = 0.015). CONCLUSION: The SAM/SM combination regimen improved the quality of life of PLWAS, however, a greater number of patients and a longer period of follow up, are necessary to arrive at a more meaningful conclusion.

The search for a predictor of CD4 cell count continues: total lymphocyte count is not a substitute for CD4 cell count in the management of HIV-infected individuals in a resource-limited setting.

Total lymphocyte count (TLC) has been recommended as a substitute for CD4 cell count for the management of HIV-infected individuals living in resource-limited settings. To confirm this, 151 TLCs and CD4 cell counts were obtained from 109 patients who had not yet started treatment and analyzed. CD4 cell counts of <200 cells/mm3 were found in 42 cases (37.8%) with TLCs of > or =1200 cells/mm3. Thus, 1 in 3 individuals would have been deprived of needed treatment. Therefore, in this setting, TLC is not a reliable predictor of CD4 cell count in HIV-infected individuals.

Is ABO blood grouping a gene marker for vitiligo?

Vitiligo is an idiopathic acquired hypopigmentary dermatosis on an otherwise normal skin. The search for the aetiopathogenesis of vitiligo has been for a long time. Despite various hypothesis and theories postulated the aetiology remains unknown. This paper examines the possible relationship between vitiligo and ABO blood groups as a gene marker. Sixty patients with vitiligo and their ABO blood grouping done. There was no statistically significant difference between their ABO blood groups and that of healthy blood donors in a teaching hospital for five years with an average of 6,000 donors per year. There is no direct relationship between their vitiligo and ABO blood groupings.

Scabies: revisit in a depressed economy.

Scabies is a highly contagious disease of the skin caused by an ectoparasite arthropod called Sarcoptes scabiei var hominis. It has a world-wide distribution and affects all ages with no specific gender predisposition. Scabies is of public health interest because certain environment factors such as overcrowding, poor hygiene, delayed treatment of primary cases and lack of public enlightenment are conducive to its spread. However, prompt and adequate therapy is rewarding and prevents spread.

Actinic keratosis: a case of sun damage in the tropics.

Sun damaged to the skin in the tropics is not an uncommon event. There is need for a high index of suspicion especially in patients with outdoor occupations. Prompt diagnosis and therapy will prevent progression to a cancerous state. We report a case of cutaneous horns secondary to actinic keratosis, a pre-cancerous condition relatively uncommon in Black skin. The importance of histological support in its diagnosis cannot be over-emphasized.

Severe clinical nutritional neurological damage in a young Nigerian detainee.

The case of a 22-year-old Nigerian detainee with features of severe clinical malnutrition, is reported. Within 2 years of prison confinement and undernutrition, he developed features of severe malnutrition, with severe sensory and motor neuropathy of the lower limbs, and pulmonary tuberculosis. Despite intensive nutritional rehabilitation, patient did not regain the use of his lower limbs. The initial economic constraint in the management is highlighted.