Purpura thrombopénique amégacaryocytaire acquis: Penser au lupus érythémateux systémique

L'amegacaryocytose acquise est exceptionnellement décrite au cours d'un Lupus Erythémateux Systémique (LES) à Madagascar. Nous rapportonsla première observation d'un Purpura Thrombopénique Amegacaryocytaire Acquis (PTAA) simulant un Purpura Thrombopénique Idiopathique (PTI)révélateur d'un LES. Il s'agissait d'une femme de 24 ans, sans  antécédents particuliers. Elle présentait un syndrome hémorragique avec une thrombopénie à 10 000/mm3. Le diagnostic de PTI était retenu avant l'hospitalisation. Elle avait reçu une corticothérapie mais ceci n'était pas suivi d'amélioration. A l'unité de Dermatologie, elle se plaignait d'une baisse de l'acuité visuelle. Elle était en bon état général. On retrouvait unetachycardie à 110 bpm, un érythème malaire en verspertilio typique et une pâleur cutanéo-muqueuse. Une hémorragie oculaire bilatérale était objectivée à l'examen ophtalmologique. Les examens paracliniques  montraient une thrombopénie à 31000/mm3, une anémie microcytaire à 48g/dL. Les examens immunologiques étaient non réalisés. Un LES avec atteinte cutanée et hématologique était retenu. Un bolus de corticothérapie était administrée associée à une transfusion sanguine. L'évolution était marquée par l'apparition d'un signe d'engagement cérébral faisant suspecter un neurolupus. Le scanner cérébral révélait une hémorragie  cérébrale avec une hydrocéphalie aigue traitée par un inhibiteur de 'anhydrase carbonique mais le neurolupus n'était pas écarté. L'anémie disparaissait par contre la thrombopénie s'aggravait à 16000/mm3. Lemédullogramme montrait l'absence des mégacaryocytes. L’évolution était favorable après un relais par une Sous un bolus de corticothérapie suivipar la dose de 1 mg/kg/j à dose dégressive à huit mois de suivi. Les atteintes neurologiques, ophtalmologiques et hématologiques étaientcompatible avec le diagnostic d'un LES. La persistance d'une thrombopénie doit faire suspecter une amegacaryocytose. Le myélogramme étaitindispensable pour poser le diagnosti

Population genomics of mycobacterium ieprae reveals a new genotype in Madagascar and the Comoros

Human settlement of Madagascar traces back to the beginning of the first millennium with the arrival of Austronesians from Southeast Asia, followed by migrations from Africa and the Middle East. Remains of these different cultural, genetic, and linguistic legacies are still present in Madagascar and other islands of the Indian Ocean. The close relationship between human migration and the introduction and spread of infectious diseases, a well-documented phenomenon, is particularly evident for the causative agent of leprosy, Mycobacterium leprae. In this study, we used whole-genome sequencing (WGS) and molecular dating to characterize the genetic background and retrace the origin of the M. leprae strains circulating in Madagascar (n = 30) and the Comoros (n = 3), two islands where leprosy is still considered a public health problem and monitored as part of a drug resistance surveillance program. Most M. leprae strains (97%) from Madagascar and Comoros belonged to a new genotype as part of branch 1, closely related to single nucleotide polymorphism (SNP) type 1D, named 1D-Malagasy. Other strains belonged to the genotype 1A (3%). We sequenced 39 strains from nine other countries, which, together with previously published genomes, amounted to 242 genomes that were used for molecular dating. Specific SNP markers for the new 1D-Malagasy genotype were used to screen samples from 11 countries and revealed this genotype to be restricted to Madagascar, with the sole exception being a strain from Malawi. The overall analysis thus ruled out a possible introduction of leprosy by the Austronesian settlers and suggests a later origin from East Africa, the Middle East, or South Asia.Immunogenetics and cellular immunology of bacterial infectious disease

Excellent response of infantile orbital hemangioma to propranolol

Fandresena A Sendrasoa, Irina M Ranaivo, Naina H Razanakoto, Malalaniaina Andrianarison, Lala S Ramarozatovo, F Rapelanoro Rabenja Department of Dermatology, University Hospital Joseph Raseta Befelatanana, Antananarivo, Madagascar Abstract: Infantile hemangiomas are the most common vascular neoplasm that present in infancy, with more than half affecting the head and neck region. Periocularly, hemangiomas may be complicated by visual loss through induction of strabismal, deprivational, or anisometropic astigmatism. We report a case of a 5-year-old girl who presented with orbital hemangioma with potential risk of visual loss who had excellent response to propranolol. Keywords: hemangioma, orbital, propranolo

Pulmonary Tuberculosis and Lepromatous Leprosy Coinfection

Simultaneous occurrence of leprosy and pulmonary tuberculosis is reported infrequently in the modern era. We report a case of pulmonary tuberculosis diagnosed in patient being treated with glucocorticoids for complications of leprosy (type II reaction). Physicians should recognize that the leprosy patients treated with glucocorticoid may develop tuberculosis

Misuse of Topical Corticosteroids for Cosmetic Purpose in Antananarivo, Madagascar

This cross-sectional study was conducted in Antananarivo, Madagascar, from June to September 2012. We aim to evaluate the misuse of TC on the face for cosmetic purpose and the adverse effects due to its application. A questionnaire-based analysis was done among females who use topical corticosteroids on the face for cosmetic purpose. Of the 770 women questioned, 384 (49,8%) used topical corticosteroids for cosmetic purpose whose mean age was 38 years (range 16–73 years). Two hundred and sixty-one females (68%) used TC combined with handcrafted cosmetics, and 123 (32%) used TC alone. “Pandalao,” which contains salicylic acid, peppermint oil, lanolin, powder of Juanes de Vigo (mercury powder), and Vaseline, is the most handcrafted cosmetic combined with TC in our study (used by 29,4% respondents). Only one (0,26%) had obtained the TC by physician’s prescription, 234 (61%) from cosmetic retailers, 92 (23%) directly from local pharmacies, 49 (12%) from beauticians, and 15 (4%) from unspecified sources. Lightening of skin color was the main reason for using TC in 44,8% of respondents in the absence of any primary dermatosis. Pigmentation disorders (63,2%) and cutaneous atrophy (52,1%) were the most adverse effects noted

Complexes of lithium tetrahydroaluminate with NNN'N'-tetra-methylethane-12-diamine(tmen). Crystal structures of [\{Li(tmen)-(AlH4)\}2] and [Li(tmen)2][AlH4] and the use of the 6Li-\{1H\} nuclear Overhauser effect to study LiAlH4 and LiBH4 in donor sol

Two crystalline complexes (1∶1 and 1∶2) of LiAlH4 with N,N,N′,N′-tetramethylethane-1,2-diamine (tmen) have been isolated. A crystal structure determination of the 1∶1 complex showed that it formed centrosymmetrical dimers in which [AlH4]– anions and [Li(tmen)]+ cations are linked by µ-hydrogen bridges. Bond lengths and angles within the non-planar eight-membered rings are Al–H 1.55(3), Li–H 1.99(3) Å, H–Li–H 131(1) and H–Al–H 112(1)° and the exocyclic Al–H distance was 1.53(4) Å. Cryoscopic data indicated that the dimeric structure with Li–H–Al bridges was preserved in benzene solution and measurements of the 6Li-{1H} nuclear Overhauser effect (NOE) showed the presence oH–Al interactions. The 1∶2 adduct [Li(tmen)2][AlH4] 2, which crystallised with an ionic NaCl structure, was converted into 1 by heating under vacuum at 120 °C. The NOE measurements on solutions of 2 in benzene showed the presence oH–Al interactions even when a large excess of tmen was present. Aluminium-bound hydrogen was shown to be near to lithium in solutions of LiAlH4 in diethyl ether, tetrahydrofuran, mono- and di-glyme [MeO(CH2)2O(CH2CH2O)nMe, n = 0 or 1]. The NOE measurements on solutions of LiBH4 in Et2O and NMR spectra of partially deuteriated species suggested the formation of contact ion pairs, witH4B interactions which were fluxional on the NMR time-scale

A Case of Fluoroquinolone-Resistant Leprosy Discovered after 9 Years of Misdiagnosis

We report a case of misdiagnosed leprosy in a 21-year-old Malagasy male, who, improperly treated, developed secondary mycobacterial resistance to fluoroquinolone. The patient contracted the infection 9 years prior to the current consultation, displaying on the right thigh a single papulonodular lesion, which progressively spread to the lower leg, back, and face. Initial administration of ciprofloxacin and prednisolone led to temporary and fluctuating improvement. Subsequent long-term self-medication with ciprofloxacin and corticosteroid did not heal the foul and nonhealing ulcers on the legs and under the right sole. Histopathological findings were compatible with lepromatous leprosy. Skin biopsy was positive for acid-fast bacilli and PCR assay confirmed the presence of a fluoroquinolone-resistant strain of Mycobacterium leprae (gyrA A91V). After 6 months of standard regimen with rifampicin, clofazimine, and dapsone, clinical outcome significantly improved. Clinical characteristics and possible epidemiological implications are discussed