Nail dystrophy: a rare sign of sarcoidosis

A 29-year-old woman presented to our clinic for subungueal hyperkeratotic lesion of the fourth left toenail. In 1997, she developed systemic sarcoidosis with lung and cutaneous lesions. The patient required gradually tapered systemic corticosteroids for 4 years and methotrexate for 1 year to control lung disease. A few months previously a hyperkeratotic verrucous lesion developed beneath the distal portion of the forth left toenail plate. There was no history of trauma. A biopsy specimen of the nail bed revealed epithelioid granulomas in the dermis without central necrosis. An X-ray of the feet showed severe osteolysis of the terminal phalanx of the forth left toenail. After 2 weeks application, once daily, of hight potency topical steroids, the subungueal hyperkeratosis rapidly improved without relapse after eight months. Nail dystrophy in sarcoidosis is rare. The most common nail changes described in sarcoidosis include thickening of the nail plates associated with fragility and longitudinal ridging , brown discoloration of the nail bed , convex nails and layering, splinter hemorrhage also occur. Such changes are usually associated with lupus pernio and cystic bone change of the phalanx. Our patient did not show lupus pernio like lesions, but radiological examination of the left foot showed bone cyst of the terminal phalanx. Treatment options for nail dystrophy in sarcoidosis include systemic treatment with 10mg/day of prednisone and 200mg/day of hydroxychlorochine sulphate, hight- potency topical steroids application once daily and steroid injections into the nail fold

Métastases cutanées révélant un adénocarcinome bronchique

Nous rapportons le cas d’un cancer bronchique révélé par des nodules cutanés métastatiques du cuir chevelu. Ce mode de découverte assez fréquent est souvent associé à un mauvais pronostic. Cette observation souligne l’intérêt de rechercher un cancer primitif pulmonaire en cas de localisation secondaire cutanée.English abstractWe report the case of bronchial carcinoma revealed by metastatic skin nodules on the scalp. This fairly common mode of discovery is often associated with poor prognosis. This study aims to underline the importance of directing the search for a primary lung cancer in cases of secondary skin involvement.Key words: Cutaneous metastases, bronchial adenocarcinoma, excisional biops

Textilome abdominal: à propos d'un cas

Le textilome est une complication postopératoire très rare mais bien connue. Il peut s'agir d'un corps étranger composé de compresse(s) ou champ(s) chirurgicaux laissés au niveau d'un foyer opératoire. La découverte du textilome abdominale est généralement tardive. L'anamnèse est donc essentielle pour diagnostic vu que la clinique n'est pas concluante. La clinique associe des troubles chroniques du transit à des syndromes sub-occlusifs, le cliché d'abdomen sans préparation est peu contributif. L’échographie est fiable. La tomodensitométrie permet un diagnostic topographique précis. Certaines équipes proposent des explorations par IRM. Nous rapportons un cas de textilome intra abdominale, chez une patiente opérée 6 mois auparavant d'un fibrome utérin

Bee venom: a case of effectiveness on skin varicosities veins with review of its dermatological benefits

Bee venom is a very rich and varied biochemical complex, which explains the multitude of its physiological effects as well as its medical indications. In dermatology, apart from psoriasis, few studies have been conducted concerning its interest and effectiveness; however the preliminary results remain so promising and encouraging. We present a clinical case illustrating the efficacy of bee venom in cutaneous varicosities, with a review of the literature of its main dermatological indications

Madura foot: Report of a eumycetoma Moroccan case

Madura foot is a chronic infectious disease, caused by bacterial actinomycetes or by fungi. Mycetoma is endemic in tropical and subtropical areas, where it is a real public health issue. It is a rare and neglected disease in our country. The diagnosis is made by clinical picture, direct microscopic examination and histological study. The best therapeutic choice is surgical removal of the lesion, followed by medical treatment. An earlier diagnosis and treatment can elicit good results. We report a case of eumycetoma in a 33 year-old Moroccan man, rural worker, treated by Ketoconazole in 12 months, associated with surgical debridement. The evolution was marked by the complete remission of the infection

Von Zumbusch’s pustular psoriasis associated with oral terbinafine

Adverse skin reactions have been reported in 2.7% of patients receiving oral terbinafine. Less common but life-threatening reactions include acute generalized exanthematous pustulosis (AGEP), Stevens-Johnson syndrome, toxic epidermal necrolysis, exacerbation or induction of psoriasis. We report a case of a 28 year-old woman with no history of psoriasis, the patient presented generalized pustular eruption, erythroderma, prolonged fever and altered general conditions, associated with initiation of oral terbinafine. The histological analysis of the cutaneous biopsy was compatible with pustular psoriasis. The intake of terbinafine was discontinued and treatment by acitretin 25 mg/day associated with emollient cream was started. The evolution was marked by resolution of skin eruption and disappearance of the fever in a few days. The complete remission was reached 2 months later. The diagnosis of severe generalized pustular psoriasis (GPP), type Von Zumbusch associated with initiation of oral terbinafine was made. The present case indicates that terbinafine is a drug that may be associated with the development of psoriasis de novo or its exacerbation

The dilemma of treating pyoderma gangrenosum associated with monoclonal gammopathy of undetermined significance

Pyoderma gangrenosum (PG) is a rare ulcerative skin condition. It can be associated with a number of systemic diseases. Association with monoclonal gammopathy of undetermined significance (MGUS) is uncommon, but prognosis may be different depending upon the type of MGUS. Cases of MGUS- related PG reported in the literature with data concerning evolution and treatment were identified through a PubMed search. A patient with recurrent PG in the setting of a MGUS-IgA-? in our department was also included. In total, 10 cases were identified. Only the two cases with Ig populations other than IgA improved without recurrence after treatment of the PG. All the patients with MGUS-IgA showed recurrences. Early multiple myeloma was proposed for three patients with MGUS-IgA-related PG. Second or third line treatments were necessary in some cases

Cutaneous plasmacytosis: Report of a Moroccan case!!

Cutaneous plasmacytosis is a rare entity that has been reported almost exclusively in Asian countries and is usually seen in adult males. Primary cutaneous plasmacytosis clinically is characterized by multiple red-brown plaques and nodules typically located on the trunk. We report a case of a Moroccan 65-year-old man presented multiple infiltrated red plaques on the extremities and the trunk, the diagnosis of cutaneous plasmacytosis was retained without systemic involvement. To our knowledge, this is the first case of this type reported in a Moroccan adult man

The dilemma of treating pyoderma gangrenosum associated with monoclonal gammopathy of undetermined significance

Pyoderma gangrenosum (PG) is a rare ulcerative skin condition. It can be associated with a number of systemic diseases. Association with monoclonal gammopathy of undetermined significance (MGUS) is uncommon, but prognosis may be different depending upon the type of MGUS. Cases of MGUS- related PG reported in the literature with data concerning evolution and treatment were identified through a PubMed search. A patient with recurrent PG in the setting of a MGUS-IgA-? in our department was also included. In total, 10 cases were identified. Only the two cases with Ig populations other than IgA improved without recurrence after treatment of the PG. All the patients with MGUS-IgA showed recurrences. Early multiple myeloma was proposed for three patients with MGUS-IgA-related PG. Second or third line treatments were necessary in some cases

Pemphigus Vulgaris: A Clinical Study of 31 Cases (2004–2014) in Morocco

Background. Pemphigus vulgaris is a rare bullous autoimmune dermatosis whose evolution and prognosis are unpredictable. Aim. The objective was to analyze long-term outcomes in patients with pemphigus vulgaris by identifying the factors that are able to influence prognosis, in particular the phenotype of pemphigus vulgaris, age at onset, multiplicity of mucosal involvement, relapse and remission rates, and survival functions. Methods. A retrospective analysis of a cohort of 31 patients followed for pemphigus vulgaris during the period from January 2004 to January 2014. Inclusion criteria were a diagnosis of pemphigus vulgaris confirmed by histopathology and direct immunofluorescence (DIF) and a period of follow-up of at least five years from the diagnosis. The following information was collected by a single investigator. Results. In total, 67.7% of patients presented a mucocutaneous pemphigus vulgaris. Male-female sex ratio was 2.4. The median duration of patient’s follow-up was estimated at 7 (6–9) years. Multiple mucosal involvement in the oral cavity and at other mucosal sites was significantly associated with severe mucocutaneous pemphigus vulgaris (p=0.01). Multiple relapses were significantly associated with the disease severity (p=0.04). Conclusion. Poor prognosis factors were severe mucocutaneous type of pemphigus vulgaris and multiple mucosal involvement in the oral cavity and at other mucosal sites