Nadia El Fekih

Tropical medicine rounds: Acrodermatitis enteropathica: a review of 29 Tunisian cases

Introduction  Acrodermatitis enteropathica is a rare autosomal recessive disease due to an abnormality in a zinc transporting molecule.

A delayed diagnosis of lepromatous leprosy: pitfalls and clues to early recognition.

Purpose  To remind special attention to atypical symptoms of Hansen’s disease, we report a case of an atypical case due to a delayed diagnosis.

Pseudotumoral cutaneous aspergillosis in chronic granulomatous disease, report of a pediatric case.

Abstract:Invasive aspergillosis is a life-threatening condition in patients with chronic granulomatous disease (CGD). Skin invasion by Aspergillus occurs most commonly by contiguity to a neighboring cavity. We describe an unusual case of invasive cutaneous aspergillosis presented as a large burgeoning tumor in a 4-year-old girl with CGD who underwent surgical treatment for bifocal osteomyelitis of the left leg. The skin invasion occurred 4 months after a “successful” treatment of invasive pulmonary aspergillosis. Atypical presentation and diagnostic difficulties are discussed. Invasive cutaneous aspergillosis may be polymorphic. The diagnosis should be considered early in the etiological investigation of any suspicious skin lesions in CGD even in uncommon aspects such as burgeoning tumors.

Carcinomes basocellulaires multiples après radiothérapie pour cancer du cavum

INTRODUCTION Basal cell carcinoma (BCC) is a cutaneous, generally primary malignancy, most common among the elderly. We report the case of a patient presenting numerous BCCs several years after radiation therapy for nasopharyngeal cancer and discuss the risk factors for this tumor and the role played by radiation in its genesis. CASE A 30-year-old woman presented with pigmented facial lesions that had been developing over the past year. Eleven years earlier, she had had an undifferentiated nasopharyngeal carcinoma (T3N2M0), which was treated by neoadjuvant chemotherapy and then external radiation therapy. Initial cutaneous examination noted two lesions that were identified as BCC after biopsy. The tumors were excised surgically. Neither clinical nor radiological check up showed signs of basal cell nevus syndrome. DISCUSSION BCC is the most frequent malignant tumor. It is observed mainly among those aged 45-60 years. Disorders that might promote or complicate BCC should be systematically sought in young patients, especially basal cell nevus syndrome. While our patient may have had this syndrome, we found none of the other clinical or radiographic elements often observed with it. The occurrence of BCC within the irradiation area, the multiplicity of lesions, and the sufficient latency period are consistent with radiation-induced tumors. We found no reports in the literature of BCC following radiation treatment for nasopharyngeal cancer, but the occurrence of these tumors in our patient suggests the need for close supervision in such cases.Resume Introduction Le carcinome basocellulaire (CBC) est une neoplasie cutanee, le plus souvent primitive, du sujet âge. L’observation d’une patiente ayant de multiples CBC apparus apres une radiotherapie pour un cancer du cavum conduit a discuter les facteurs de risque de survenue de cette tumeur et le role tres vraisemblable de la radiotherapie dans sa genese. Observation Une patiente âgee de 30 ans a consulte pour des lesions pigmentees du visage evoluant depuis un an. Onze ans auparavant, elle a eu un cancer du cavum type UCNT (Undifferentiated carcinoma of nasopharyngeal type), classe T3N2M0, traite par chimiotherapie neoadjuvante suivie d’une radiotherapie externe. L’examen cutane initial a montre 2 lesions dont la biopsie a conclu a des CBC. Une exerese chirurgicale des lesions tumorales a ete realisee. Une naevomatose basocellulaire a ete recherchee mais le bilan clinique et radiologique a la recherche de lesions evocatrices etait normal. Discussion Le CBC est la plus frequente des tumeurs malignes. Certaines affections pouvant favoriser ou se compliquer de CBC doivent etre systematiquement cherchees chez le sujet jeune, dont la naevomatose basocellulaire. Chez notre patiente, il n’y avait pas assez d’elements cliniques ou radiographiques pour retenir cette maladie. La survenue des CBC dans l’aire d’irradiation, la multiplicite des lesions et le temps de latence compatible sont des arguments qui nous ont fait retenir l’hypothese de CBC radio-induits. Nous n’avons pas trouve dans la litterature de cas de CBC survenant apres radiotherapie pour cancer du cavum mais la survenue de telles tumeurs dans notre observation incite a une surveillance rapprochee chez de tels patients.

Tropical medicine rounds: Acrodermatitis enteropathica: a review of 29 Tunisian cases: Acrodermatitis enteropathica: a review

Introduction  Acrodermatitis enteropathica is a rare autosomal recessive disease due to an abnormality in a zinc transporting molecule.