A. Mebazaa

Childhood discoid lupus erythematosus: a Tunisian retrospective study of 16 cases.

Abstract: Discoid lupus erythematosus (DLE) is uncommon in children. The clinical features of childhood DLE are similar to those of adult DLE in presentation and chronic course. However, children have a particularly high level of transition to systemic disease. We undertook a retrospective study of 16 children with DLE ranging in age from 2 to 15 years, seen over a 9‐year period. Six were less than 10 years old at the onset of the disease. The sex ratio was equal. The frequency of childhood DLE was about 7% of the total number of DLE patients seen in our department. Photosensitivity was defined as a clinical history of induction or exacerbation of discoid lesions following sun exposure, and was present in 81% of patients. There was no progression to systemic lupus erythematosus (SLE); an average follow‐up time was 10.5 months (2–30 months). We would like to emphasize the increased frequency of childhood DLE in our country and the importance of photosensitivity. However, follow‐up data regarding transition to SLE is lacking, therefore we are unable to offer a prognosis to our patients.

A novel POLH gene mutation in a xeroderma pigmentosum-V Tunisian patient: phenotype-genotype correlation.

XP occurs at higher frequency in Tunisia (1:10,000) than in Japan (1:22,000) (Hirai et al. 2006) and the United States (1 per million) (Kleijer et al. 2008). XP-V cells are unable to synthesize intact daughter DNA strands on UV-irradiated templates resulting from an inability to carry out translesion synthesis (Lehmann et al. 1975; Masutani et al. 1999). Approximately 20% of XP patients belong to XP-V complementation group (Gratchev et al. 2003). In Tunisia, XP is classified into three clinical forms: severe, intermediate with or without neurological abnormalities, and moderate (Zghal et al. 2006). Previous molecular investigation showed homogeneity of mutational spectrum in XPA and XPC genes (Ben Rekaya et al. 2009; Messaoud et al. 2010a,b). The moderate clinical form of XP is characterized by mild dermatological manifestations, no neurological abnormalities and late onset of skin cancers. The median age of onset is 4 years. Mild skin symptoms and late onset of skin tumours have been already described in XP-V (Tanioka et al. 2007), XP-F (Matsumura et al. 1998) and XP-E patients (Rapic-Otrin et al. 2003). Post-UV cell survival in the presence or absence of caffeine (Itoh et al. 2000), unscheduled DNA synthesis (UDS) and detection of polymerase eta employing Western blot (Tanioka et al. 2007) cannot define exactly the molecular defects are in the polymerase eta. These laboratory assays are used to find out the UV sensitivities of the patients’ cells and the DNA repair status of their cells as

Mélanose pustuleuse néonatale transitoire

Transient neonatal pustular melanosis is a common, benign, but little known dermatosis in newborns. Diagnosis of transient neonatal pustular melanosis is made clinically, by the presence of vesiculopustular and pigmented macular skin lesions. This benign spontaneously regressive dermatosis should be distinguished from several serious infectious neonatal diseases. We report a case of transient neonatal pustular melanosis and discuss the nosologic problems and differential diagnosis of this entity.

P 05 : Une tuberculose qui fait parler d’elle

Introduction La tuberculose oro-pharyngee est une variante rare de la tuberculose cutanee. Nous rapportons un cas de tuberculose oro-laryngee mimant une pyostomatite vegetante. Observations Une femme âgee de 27 ans nous a ete adressee pour une gingivite erosive evoluant depuis 1 an. A l‘interrogatoire elle rapportait une dysphonie evoluant depuis 3 ans ainsi qu’une perte de poids estimee a 5 kg en 6 mois. L’examen physique trouvait de multiples pustules friables sur base erythemateuse et infiltree, siegeant sur la muqueuse labiale et gingivale. Le palais presentait un aspect franchement papillomateux voire vegetant. Le reste de l’examen etait sans particularites. Le diagnostic de pyostomatite vegetante semblait le plus probable. Un examen oto-rhino-laryn- gologique (ORL) sous anesthesie generale a ete pratique et avait note un aspect infiltre de la glotte, du nasopharynx et des cordes vocales ainsi qu’une hypertrophie du mur posterieur du pharynx. Un scanner du massif facial avait note la presence d’une infiltration du larynx, du pharynx, se rehaussant apres injection de produit de contraste. Des biopsies de la muqueuse buccale et laryngee ont revele une acanthose avec des ulcerations focales ainsi qu’un granulome tuberculoide sans necrose caseeuse au niveau du chorion. L’intra-dermo-reaction a la tuberculine etait fortement positive. La radiographie du thorax et le scanner thoracique trouvait des signes suggestifs de primo-infection tuberculeuse. La recherche du bacille de Koch etait negative dans les crachats. La patiente a beneficie de 6 mois de traitement anti-tuberculeux associant 2 mois de HRZE et 4 mois de HR. Une amelioration etait notee a partir du 3 e mois avec regression de la dysphonie et amelioration de l’etat local buccal avec une guerison complete a 6 mois. Conclusion La tuberculose oro-pharyngee reste de diagnostic difficile etant donne sa rarete et son grand polymorphisme lesionnel, pouvant etre deroutant pour le clinicien. Toute lesion chronique de la bouche devrait inciter a la pratique de biopsies au mieux guidees par une endoscopie ORL.

P-121: Prevalence and risk factors of hypertension among pre- and postmenopausal women: a cross-sectional study in great Tunis region (Tunisia)

OBJECTIFS The prevalence of the risk of CVD and hypertension in women increases when they reach menopause. The aim of this study was to assess the prevalence and risk factors of hypertension in pre-menopausal (Pre-M) women and post-menopausal (Post-M) women and determine whether years since menopause are associated with hypertension. MéTHODES: This cross-sectional study was used a two-stage cluster sampling method to select a representative sample of the great Tunis population. A total of 1.484 women (776 Pre-M and 708 Post-M), aged 35 to 69 years were included. Definition and classification of hypertension was performed according to guidelines from the JNC-7 report RéSULTATS: The overall prevalence of hypertension among women in Great Tunis region was 40.7%, and it increased with age. Post-M had a higher prevalence of hypertension than Pre-M (58.5% vs 25.1%, p<0.001). Post-M had higher systolic and diastolic blood pressure, triglyceride, total cholesterol, fasting plasma glucose and body mass index than Pre-M. Regression analysis found that the ORs for hypertension increased with age and BMI. Also the personal history of diabetes (OR=2.18, 95% CI: 1.56-3.04, p<0.001) and dyslipidemia (OR=1.60, 95% CI: 1.20-2.13) were associated with hypertension in all participants. The age-adjusted OR (1.63, 95% CI: 1.51-1.76, p<0.001) for hypertension were significantly higher in Post-M than in Pre-M, and the risk of hypertension reached a peak level in the lower 5-year group (OR=1.54; 95% CI, 0.88-2.68, p=0.02). CONCLUSION After adjusting for confounders, this study showed that postmenopausal status was an independent risk factor for hypertension. The risk of hypertension was highest in Post-M with less than or equal to 5 years from menopause.

Clarithromycin Induced Psoriasis in a 37-Year Old Man

Many drugs may induce psoriatic lesions or exacerbate preexisting psoriasis. We report an exceptional case of psoriasis vulgaris probably induced by clarithromycin. A 37-year-old man was prescribed for pharyngitis clarithromycin 500mg twice a day. On the third day of treatment, he presented a non pruriginous erythemato-squamous eruption, of trunk and limbs. Skin biopsy showed a typical aspect of psoriasis vulgaris. The drug was interrupted and the patient was treated by topical corticoids with rapid improvement.