Maodo Ndiaye

Behçet's disease in black skin. A retrospective study of 50 cases in Dakar.

INTRODUCTION Although Behçets disease is well-documented in Eastern populations, epidemiologic data in Sub-Saharan African population is scarce. The aim of this study was to define the epidemiologic and therapeutic aspects as well as clinical course of Behçets disease in African black population. RESULTS The study included 50 patients with Behçets disease. The average age was 32 (18-67) years. A total of 31 patients were men and 19 were women. Two patients had a positive family history of Behçets disease. The oral and genital aphthous lesions were present in 100% of patients. The pathergy test was positive in 16 patients (32%). Following skin conditions were observed: pseudofolliculitis in 15 patients (30%), acneiform papules in 6 patients (12%), erythema nodosum in 4 patients (8%) and leg ulcers in one patient. Ocular involvement was reported in 22 patients (44%) and joint involvement in 20 patients (40%). Neurological abnormalities were noted in 12 patients (24%). Gastrointestinal involvement with wide and deep ulcerations in the ileocecal region was observed in a patient. As treatment, a combination of oral corticosteroids and colchicine was used in 97% of our patients. Thalidomide was introduced in 3 patients and anticoagulation treatment in 19 patients. Clinical improvement was noted in 25 patients (50%), recurrence in 14 patients (28%) and 3 patients were lost to follow (6%). CONCLUSION The Behçets disease is not uncommon in black skin and generally affects young adults. Severe aphthous ulcers of the oral cavity and genital area are the most consistent finding.

Epidemiologic and clinicopathologic aspects of Leprosy in Dakar; evaluation of 73 new cases

Hundreds of new leprosy cases are still diagnosed in Dakar despite all the efforts in the struggle by the national program for elimination of leprosy by the Institute of Applied Leprosy in Dakar. The aim of our study was to evaluate the epidemiological, clinicopathological and outcome of new cases of leprosy. A prospective study was conducted over a period of one year listing all new cases of leprosy based on clinical diagnosis, bacteriology and histology. 73 new cases were recorded. The sex ratio was 1.5 and the mean age of 39.5 years. Children aged from 0 to 15 years old represented 12%. The clinical forms were rated in order of decreasing frequency Borderline 47.94%, 30.13% lepromatous lepromatous, indeterminate 8.21, borderline lepromatous 6.84, TT: 5.47%, 1.36 and neurological bb%. Neurological signs were enlarged nerve in 50 cases, a neurological deficit in 16 cases and a sensitive deficit in 16 cases. The complications were burns and ulcerations in 10 cases, a claw in 7 cases, a reversal reaction in 7 cases, erythema nodosum in 4 cases and neuritis in 8 cases. The number of new cases mutilated was 24.65%. The smear was positive in 42% and histology contribution in 91.37% of cases. Our study highlights the significant number of patients with multibacillary contagious, affected children, the high proportion of disability grade 2/OMS reflecting the delay in diagnosis. This delay is due to ignorance, to traditional treatments and low socio-economic status and lack of trained diagnostic teams in different areas apart from referral centres.

Extranodal natural killer/T‐cell lymphoma, nasal type, in Senegal

The distribution of extranodal NK/T‐cell lymphoma (ENKTCL) is highly inhomogeneous throughout the world. In Sub‐Saharan Africa, despite the precocity of Epstein‐Barr virus (EBV) infection and its endemicity, ENKTCL remains exceptionally reported. The purpose of this study was to report the epidemiological, clinical, paraclinical, and evolutionary characteristics of ENKTCL at the Aristide LeDantec University Hospital in Dakar, Senegal.

Epidemiological and clinical aspects of pemphigus in Senegal

Background: The purpose of this study was to specify the epidemiological and clinical characteristics of pemphigus in the Department of Dermatology of the University Hospital of Dakar. Patients and Methodology: All medical records of patients seen for pemphigus in our department over a 11-year period were analyzed retrospectively. Results: We collected 105 cases of pemphigus, corresponding to a frequency of 10 cases/year and a hospital prevalence of 2.7%. Thus, pemphigus held the second rank of blistering autoimmune bullous diseases after bullous pemphigoid. The mean age of patients was 47.62 years and the age group [40-59 years] was predominantly affected (28 cases; 45 %). There were 41 femeles and 21 men (F/M ratio: 2). We did not find an endemic focus in our country. Clinical forms were dominated by pemphigus foliaceus (30 cases; 48.5 %), followed by pemphigus vulguaris (19 cases; 30.6 %) and finally by pemphigus erythematosus (13 cases; 21%). In 16 cases (25 %), the pemphigus had begun after the consumption of a traditional medicinal plant (8 cases). An associated toxidermia was found in12 cases. Pruritus was present in 43 patients (69.35%). Discussion: In Senegal, pemphigus are common diseases, but without however an endemic focuc. They occur in young women, with a predominance of superficial forms, especially pemphigus foliaceus. The presence of pruritus and associated toxidermia to traditional medicinal plants are common.

The characteristics of severe forms of psoriasis on pigmented skins: A retrospective study of 102 cases in Dakar, Senagal

Background: Severe forms of psoriasis can be life-threatening for patients. Our objective was to determine the epidemiological, clinical, therapeutic aspects and outcome of severe forms of psoriasis. Methodology: A 18 years retrospective study conducted in the department of Dermatology at Le Dantec hospital listed all the severe forms of psoriasis. Results: We have collected 102 cases of severe forms. The sex ratio was 1.55 and the average age of 47 years. The family histories of psoriasis were reported in 5 patients. Arterial hypertension was noted in 10 patients, diabetes in 4 patients and obesity in 6 patients. Smoking and alcoholism were found respectively in 10 cases and 7 cases. The average duration of the lesions was 2 years. Phytotherapy was reported in 62 patients (62%). Pruritus was present in 86 patients (84%). The clinical forms of psoriasis were: erythroderma in 76 cases (74.5%), psoriatic arthritis in 14 cases (13.7%) and a pustular form in 12 cases (11%). HIV serology was positive in 12 patients. All patients had received a treatment with topical corticosteroids and emollients. Methotrexate was initiated in 57 patients and retinoids in 27 cases. The outcome was favorable in 67 patients (65%). We recorded 6 deaths (6%). Conclusion: The large use of oral phytotherapy medicines and inappropriate treatment precipitated or speeded up the occurrence of severe forms of psoriasis among our patients.

Stevens Johnson Syndrome and Toxic Epidermal Necrolysis Induced by Nevirapine among HIV-Infected Pregnant Women: Five Cases

Introduction: The nevirapine is the most widely accused drug in toxidermias in patients living with HIV. It is responsible for toxic epidermal necrolysis called Lyell syndrome or Stevens Johnson syndrome, severe during pregnancy. We report five cases in pregnant women who are HIV-positive. Case reports: Five pregnant women aged 35 years on average with a mean gestational age of 29.6 weeks of amenorrhea were HIV1-positive.The mean CD4 count was 416/mm3. They had severe toxidermia such as Lyell syndrome or Stevens Johnson syndrome. These toxidermias appeared on average 26 days after taking antiretroviral triple therapy including nevirapine as part of the prevention of mother-to-child transmission of HIV (PMTCT). The outcome was favorable after discontinuation of antiretrovirals. Nevirapine was substituted with lopinavir/ritonavir. Newborns had received antiretroviral prophylaxis and were not infected with HIV. Conclusion: The nevirapine toxidermia is common during antiretroviral therapy. These toxidermia are severe during pregnancy related to maternal and fetal vital risks. The replacement of nevirapine with an anti-protease is a therapeutic alternative in our resource-limited countries.

F16 : Histoplasmose multifocale à Histoplasma capsulatum var duboisii chez un Sénégalais de 22 ans sans immunodépression prouvée

Introduction L’histoplasmose africaine est une mycose profonde le plus souvent cutanee, osseuse et ganglionnaire posant souvent des problemes therapeutiques. Nous en rapportons un cas multifocal avec atteinte cutanee et survenant sur chez un garcon de 22 ans sans immunodepression prouvee. Observation SS âge de 22 ans, originaire du Senegal oriental etait refere apres 7 mois d’evolution de lesions papulo-nodulaires sous cutanees asymptomatiques, disseminees. A l’admission en juillet 2014, l’etat general etait conserve. On notait des lesions cutanees polymorphes faites de nodules sous cutanes dissemines atteignant le cuir chevelu, de papulo-nodules ombiliques et de nodules bourgeonnants, charnus siegeant au visage et a la face anterieure du thorax. Il existait des adenopathies sous mandibulaires, axillaires, inguinales non inflammatoires et une splenomegalie type III selon Hackett. Les examens des appareils pleuro-pulmo- naire et locomoteurs etaient normaux. La mycologie des lesions cutanees et ganglionnaires avait mise en evidence des levures d’Histoplasma capsulatum var duboisii. Le liquide ganglionnaire etait caseeux avec absence de BAAR a la culture. Les serologies VIH1, 2 et HTLV etaient negatives. Une amelioration partielle etait notee sous d’Itraconazole 400 mg/jour suivie d’une aggravation secondaire des lesions cutanees. Certaines devenaient tumorales ulcero bourgeonnantes avec envahissement osseux. Le patient rehospitalise en fevrier 2015, un traitement par Amphotericine B a raison de 0,5 mg/kg/j puis 1 mg/kg/j par voie intraveineuse fut entrepris mais de facon irreguliere suite a un epuisement financier. Son exeat a ete fait apres six mois d’hospitalisation. Le deces est survenu a domicile. Discussion L’observation est originale par le polymorphisme des lesions cutanees et l’association a une probable atteinte viscerale et malgre l’absence d’immunodepression prouvee. Elle est demonstrative des problemes poses par la maladie. L’aspect caseeux des adenopathies pretait a confusion avec une tuberculose d’ou la necessite d‘un examen microbiologique complet devant toute adenopathie en zone tropicale. L’echec therapeutique peut etre impute en grande partie a l’indisponibilite de l’Amphotericine B dans le territoire national. En effet ce medicament etait irregulierement commande depuis la France en fonction des moyens financiers des parents. D’autre part, l’echec peut etre lie a un defaut de pharmacocinetique de la molecule car l’enkystement de certaines lesions ne favoriserait pas la penetration de la molecule dans ces dernieres.

Une présentation atypique tumorale d’un mycétome actinomycosique dorsolombaire

Mycetomas are localized chronic inflammatory infectious diseases involving subcutaneous tissues, skin and bones. We report a case of mycetoma in a 40-year-old farmer from the north of Senegal. The clinical appearance of the lesions suggested primarily the diagnosis of a soft tissue malignant tumor. Mycetoma diagnosis was confirmed by histopathologic evidences and growth of Actinomadura pelletieri in cultured samples. The evolution was good under a triple antibiotic therapy combining cotrimoxazole, amoxicillin-clavulanic acid and streptomycin for 12 months.