[Dapsone efficacy in lupus miliaris disseminatus faciei: two cases]. / Efficacité de la dapsone dans deux cas de lupus miliaire disséminé de la face.

BACKGROUND: Lupus miliaris disseminatum faciei (LMDF) is a rare, chronic and benign facial dermatosis that is regarded as an enigmatic diagnostic and therapeutic entity with spontaneous regression in 2 to 4 years leaving pock-like scars. CASE REPORT: We present two cases of LMDF: the first concerns a 46-year-old woman who 6 months earlier presented a papular and pustular eruption on her face leaving small pitted scars. The inefficacy of treatment with cyclines, metronidazole and crotamiton as well as the clinical and histological examination results allowed a diagnosis of lupus miliaris disseminatus faciei to be made. The patient was placed on dapsone 100mg per day, which led to a remarkable improvement in the second week, but with depressed scars. The second case concerned an 18-year-old man who for 3 months had been presenting red-brown papules of the face that were resistant to cyclines and to topical retinoids and caused scarring. This clinical aspect, consolidated by the histological result, allowed the diagnosis of LMDF to be made. Administration of dapsone 100mg per day resulted in improvement from the first month, although there were residual cupuliform scars. DISCUSSION: Dapsone appears to be effective in the management of this disease, as illustrated in our two case reports. However, further studies are needed to confirm these results.

[Erysipelas of the face revealing a mucormycosis]. / Érysipèle de la face révélant une mucormycose.

BACKGROUND: Mucormycosis is an opportunistic fungal infection, typically affecting immunocompromised patients. Rhino-orbital location is the most frequent form with cerebral blood vessels invasion and a fatal outcome. CASE REPORT: An immunocompetent 38-year-old woman, with previous history of primary cutaneous mucormycosis, was admitted for a febrile erythemato-oedematous lesion of the face with well-demarcated edge evoking erysipelas. No cutaneous portal of entry was identified. Oral cavity examination found an ulceronecrotic lesion of the hard palate. Diagnosis of mucormycosis was retained after nasal endoscopy and histological findings. The patient was first treated for erysipelas, then by ascending dose of intravenous amphotericin B. A good outcome was observed despite the occurrence of nephrotoxicity which normalized by alkaline hyperhydratation. Healing was obtained after 1month of effective dose leaving cleft palate sequelae. DISCUSSION: Mucormycosis occurs rarely in immunocompetent, even more if it is a second episode. Affecting the face, it may simulate or be revealed by superficial skin infection. Within that, a meticulous otorhinolaryngeal examination is required when the portal of entry is not obvious.

Synovial hemangioma of the ankle.

Synovial hemangioma is a rare benign vascular tumor that arises from any synovium-lined surface. The most typical form is the intra articular type in which the tumor forms a mass lined by synovial membrane. We report a case of a juxta articular synovial hemangioma of the ankle.

Furuncular myiasis: unusual case of African Dermatobia hominis.

Human cutaneous myiasis is a common disease in endemic tropical zones. Increased international travel has produced increases in imported cases. We present an unusual patient with myiasis infestation of the leg caused by Dermatobia hominis, which manifested after returning from the Democratic Republic of Congo. This particular infestation has not been reported in Morocco prior to this case. Furuncular cutaneous miyasis must be considered when travellers exhibit draining nodules. Medical treatment consists of occlusion of the furuncular punctum with vaseline to stimulate extrusion of the larva or surgical debridement under local anesthesia.

[Glomus tumors: anatomoclinical study of 14 cases with literature review]. / Tumeurs glomiques: étude anatomoclinique de 14 cas avec revue de littérature.

BACKGROUND: Glomus tumor is a neuro-myo-arterial benign hamartoma. It is a relatively uncommon lesion. The aim of this study is to define all the unusual localizations of glomus tumor. PATIENTS AND METHODS: From January 1999 to December 2006, we included in this retrospective study all patients who had the classic triad of symptoms with histological exam. We analysed epidemiological, clinical and therapeutical features of our patients. RESULTS: Fourteen patients were found to have histopathologically-proven glomus tumors. The patients, eight men and six women, had mean of age around 42 years. Three unusual locations were found: forearm, sacred region and parasternal. Most glomus tumors occur in the toes and fingertips. They are difficult to diagnose, despite painful symptom, because of their unusual locations. CONCLUSION: Glomus tumors are rare vascular tumors. The usual presentation is a solitary nodule in the distal portion of a digit, but can also occur wherever, with localizations unaccustomed and disconcerting.

[Pseudo-Kaposi's sarcoma secondary to superficial arteriovenous malformation: Stewart-Bluefarb syndrome]. / Pseudomaladie de Kaposi secondaire à une malformation artérioveineuse superficielle: syndrome de Stewart-Bluefarb.

BACKGROUND: Pseudo-Kaposi's sarcoma or Stewart-Bluefarb subtype acroangiodermatitis is uncommon and is caused by arteriovenous fistula and malformation. We report a new case. CASE REPORT: A 33-year-old man presented with painful red-violet plaque on the dorsum of the toes with angiomatous nodules on the sole. Histological and immunohistochemical studies for CD34 were consistent with Kaposi's sarcoma. Doppler ultrasonography and femoral angiography showed multiple distal arteriovenous shunts. Free-flow embolisation with fragments of Ethibloc gelatin sponge was performed and arteriography, performed immediately afterwards, showed delayed venous drainage. The outcome was good with complete drainage of the angiomatous lesions. DISCUSSION: Pseudo-Kaposi's sarcoma Stewart-Bluefarb subtype begins early in life in male subjects, with unilateral skin lesions. It bears clinical and histological resemblance to Kaposi's sarcoma. Doppler ultrasonography and angiography show arteriovenous fistulas that classically develop at shunts, explaining the role of traumatism and high vascular pressure in the genesis of this disease.

[Cutaneous blastomycosis revealing intravascular B-cell lymphoma: a case in Morocco]. / Blastomycose cutanée révélant un lymphome B intravasculaire: une observation marocaine.

Blastomycosis is a systemic fungal infection caused by a thermally dimorphic fungus, Blastomyces dermatitidis. The incidence in immunocompromised patients has increased in the last two decades. A 55-year-old man consulted for inflammatory nodules on the forearm. Biopsy of one nodules showed a pseudoepitheliomatous hyperplastic epidermis overlaying a dense agranulomatous inflammatory infiltrate containing free-formed ovoid bodies enclosing giant macrophageous cells. These findings were consistent with blastomycosis. After a month of treatment cutaneous lesions regressed partially but the patient's general status continued to deteriorate with the appearance of an edematous-ascitic syndrome and icterus. Laboratory blood testing demonstrated cholestasia and abdominal ultrasound showed hepatosplenomegaly. Needle liver biopsy revealed giant B-cell lymphomatous infiltration of the hepatic ducts. The patient's condition worsened rapidly and he died five months after diagnosis despite four rounds of chemotherapy. Blastomycosis is rare in Morocco. Primary infection is usually a pneumonic process. Isolated cutaneous infection is possible but uncommon. To our knowledge the association of blastomycosis and intravascular lymphoma has not been previously reported. In immunocompromised patients, clinical findings can be alarming and the outcome can be rapidly fatal.

[Adverse effects of BCG revaccination: 12 cases]. / Complications de la revaccination par le BCG: 12 observations.

INTRODUCTION: Calmette-Guérin bacillus (BCG) is a live attenuated strain used in tuberculosis vaccination. Local and systemic side-effects, although rare, are associated with BCG vaccine. They are common in cases of overdose and with poor vaccination techniques. These complications also occur in some cases of revaccination. PATIENTS AND METHODS: This was a retrospective study over a period of 5 years between January 2000 and March 2005. 12 patients presenting complications following revaccination with BCG were observed. Patients were revaccinated with BCG following a negative intradermal reaction test. The following parameters were recorded: age, gender, history, vaccination method, type of complication, treatment and outcome. RESULTS: There were 10 men and 2 and women of mean age 21 years (19 to 23 years). Mean time to consultation was 4 weeks. Complications comprised subcutaneous abscess in 8 cases, deep chronic ulcers in 4 cases complicated by humeral osteitis in one case. The dose administered was 0.1 ml in 9 patients and 1 ml in 3 others (i.e. 10 times the recommended dose). Six patients had extensive and progressive ulceration, with one positive culture, the presence of a granuloma with caseum necrosis and one case of humeral osteitis, and specific treatment was given. DISCUSSION: Revaccination is no longer recommended by the WHO since efficacy is considered to be low or even nil. Intradermal injection is the reference method for BCG vaccination. Technical errors such as injection of an excessively high dose of the vaccine or subcutaneous administration of the vaccine solution increase the incidence of adverse effects. In our study, three patients erroneously received 1 ml of vaccine and the injection was too deep in 9 cases. There are few reports in the literature concerning the underlying mechanisms of these post-revaccination accidents; two major physiopathological mechanisms, infectious and immunological, are discussed. There is no consensus regarding treatment of these complications. Six of the 12 patients received specific therapy for 6 months.

[Thalidomide in adult multisystem Langerhans cell histiocytosis: a case report]. / Efficacité du thalidomide dans le traitement de l'histiocytose langerhansienne multisystémique de l'adulte: à propos d'une observation.

BACKGROUND: Adult multisystem Langerhans cell histiocytosis is an excepted disorder, which have several treatments. The purpose of this study was to test the disease-controlling effect of thalidomide in a case of adult multisystem Langerhans cell histiocytosis with cutaneomucous and hypothalamic localizations at dermatology department, of Mohammed-V military hospital, Rabat. CASE REPORT: A 43-year-old women, presented multifocal chronic Langerhans cell histiocytosis confined to cutaneous, oral cavity, perianal, mastoid and hypothalamic areas, with severe disabling ulcers in intertriginous areas, diabetes insipid and amenorrhoea. We treated with thalidomide 200 mg/day after neurological examination. A rapid initial response with total diminution of the involved skin area, and diminution of diabetes insipid. She remained in remission for 1 year. No adverse effects from treatment were observed at clinical and electrophysiological examinations. CONCLUSION: Thalidomide treatment is an adequate therapeutic measure in adult Langerhans cell histiocytosis, which is rare and difficult to treat. Our case showed the efficacy of thalidomide at cutaneomucosal and hypothalamic manifestations.

[Wound myiasis due to Wohlfahrtia magnifica. First human case in Morocco]. / Myiase des plaies dues à Wohlfahrtia magnifica (Schiner, 1862). Premier cas humain au Maroc.

Wohlfahrtia magnifica is a frequent fly in countries with high breeding activity: Australia, South Africa or Arab country The parasitological infestation occurred essentially during the summer, favourable period to the biological evolution of the flies. In this work, we report one case of wound myiasis that complicates a cutaneous lesion caused by larvae of Wohlfahrtia magnifica. This observation constitutes the first human case in our country.

[Neurological feature of Mediterranean spotted fever: a study of four cases]. / Manifestations neurologiques de la fièvre boutonneuse méditerranéenne : à propos de quatre observations.

BACKGROUND: Rickettsia conorii is the etiologic agent of Mediterranean spotted fever that is endemic in Mediterranean. EXEGESIS: We report four cases of serious form of Mediterranean spotted fever with neurological feature. Two of them 56 and 62 years old had meningoencephalitis. Two others had cerebellitis, they are aged 43 and 56. The course has been favourable with ciprofloxacin. CONCLUSION: It is a benign well-known illness in spite of apparition of severe visceral complications, which can drag the death in 2.5% of cases. Neurological feature is more frequent and present in 28% of cases. Precocious treatment prevents this unfavourable evolution.

[Histoid leprosy with erythema nodosum leprosum]. / Lèpre histoïde avec érythème noueux lépreux.

Histoid leprosy is a particular variant of lepromatous leprosy presenting as cutaneous or subcutaneous nodular and/or plaque-like lesions arising form apparently normal skin. It is characterized histologically by spindle-shaped histiocytes in interlacing bundles and whorls, containing numerous intact and rod-shaped Mycobacterium leprae. It can occur de novo or secondary in patients treated for a long course by dapsone alone. We describe a case of lepromatous leprosy treated according to the national Moroccan protocol who developed histoid lesions during his treatment by dapsone. The patient responded well to fluoroquinolone, rifampicin and clofazimine, with however, the occurrence of erythema nodosum leprosum.