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

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

Coinfection with Leprosy and Tuberculosis: A Case Series in Malagasy Patients

Mendrika Fifaliana Rakotoarisaona,1,* Tsiory Iarintsoa Razafimaharo,2,* Fandresena Arilala Sendrasoa,2,* Malalaniaina Andrianarison,1,* Naina Harinjara Razanakoto,3,* Volatantely Tobiniaina Ratovonjanahary,2,* Onivola Raharolahy,2,* Irina Mamisoa Ranaivo,4 Lala Soavina Ramarozatovo,1 Fahafahantsoa Rapelanoro Rabenja1 1Department of Dermatology, University Hospital of Analakely, Antananarivo, Madagascar; 2Department of Dermatology, University of Befelatanana, Antananarivo, Madagascar; 3Department of Dermatology, University Hospital of Mahavoky Antsimo, Mahajanga, Madagascar; 4Department of Dermatology, University Hospital of Morafeno, Tamatavy, Madagascar*These authors contributed equally to this workCorrespondence: Mendrika Fifaliana Rakotoarisaona, Department of Dermatology, University Hospital of Analakely, Antananarivo, 101, Madagascar, Tel +261 34 61 947 34, Email [email protected]: Leprosy and tuberculosis are two of the oldest and most common mycobacterial infections, caused by Mycobacterium leprae and Mycobacteium lepramatosis for leprosy and Mycobacterium tuberculosis for tuberculosis. Dual infections have been known since ancient times; however, cases remain rarely reported in the literature, even in countries where both diseases are endemic, such as Madagascar.Purpose: We report a case series of simultaneous occurrence of leprosy and tuberculosis.Patients and Methods: In this retrospective study, we reviewed the medical records of patients with leprosy registered at the Department of Dermatology, University Hospital Befelatanana, Antananarivo, Madagascar, between January 2012 and June 2021. Patients with leprosy and diagnosed as coinfected by tuberculosis were included in the study.Results: Of the 120 leprosy cases observed during the study period, coinfection with leprosy and tuberculosis was found in five patients. The mean age was 43.4 (SD 13.2) ranging, 21– 59 years. Male gender was predominant (4/5). Four patients presented with lepromatous leprosy, and one with borderline lepromatous leprosy. Three patients experienced leprosy reaction. Four cases of pulmonary tuberculosis and one case of multifocal tuberculosis were observed. The diagnosis of leprosy preceded tuberculosis in four cases, and a coinfection diagnosis was made simultaneously in one case. The average time to develop tuberculosis was 38.8 (SD 10.2) months. HIV infection, malnutrition, alcohol consumption, and long-term corticosteroid therapy were the immunosuppressive factors reported in our patients. Three patients received concomitant multidrug therapy for leprosy and tuberculosis.Conclusion: Dermatologists should be aware of the importance of screening patients affected by leprosy for latent or active tuberculosis to prevent morbidity and mortality due to coinfection and to reduce the risk of acquired resistance to rifampicin, which is the greatest risk of this association.Keywords: Madagascar, Mycobacterium leprae, rifampici

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

Synthesen und Kristallstrukturen der lithierten Silylphosphane (CMe3)2SiFP(Mes)Li(THF)3,(CMe3)2SiFLi(TMEDA)PMes und des cyclischen Silylphosphanes [(CMe3)2SiPMes)]2

Di-tert-butyldifluorsilne reacts with lithiated 2,4,6-trimethylphenylphosphane to give (CMe3)2SiFPHC6H2Me3 (1). A lithium derivative is formed in the reaction of 1 with nC4H9Li. The crystal structures of the lithium derivatives (CMe3)2SiFP(C6H2Me3)Li(THF)3 (2) and (CMe3)2SiFLi(TMEDA)PC6H2Me3(3) were determined. The phosphorus atom is planar in 2 and pyramidal in 3. A (SiPLiF)-four-membered ring is formed in 3. LiF-elimination leads to the formation of the (SiP)-four-membered ring (4). The ring system of 4 is completely asymmetrical, indicating that the sterical limits of the dimerisation of the intermediate silaphosphene have been reached. Both 2 and 3 react with CMe3SiF3 to give the substituted compound (CMe3)2SiFP(SiF2CMe3)C6H2 Me3 (5)

Lithio-di-t-butylfluorsilylphenylphosphan; im Kristall ein (SiFLiP)2-Achtring

Di-t-butylfluorosilylphenylphosphane (I) reacts with CMe3Li to give the lithium compound [(CMe3)2SiFLi(THF)2PC6H5]2 (II) and butane. The crystal structure of II has been determined. The Si---P bond length (217.1 pm) in the eight-membered ring is extremely short. The Si---P spin coupling constant (84.12 Hz) in II is remarkably large. LiF elimination from II leads to the formation of the four-membered (Si---P) ring III. The bis(fluorosilyl)phosphane IV is formed in the reaction of II with Me2SiF2

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