Toxic epidermal necrolysis: a retrospective analysis of 17 cases from Central Tunisia

Toxic epidermal necrolysis (TEN), also known as Lyell’s syndrome, is a rare, life-threatening and wide-spread exfoliative disease of the skin and mucous membrane that is most commonly drug-induced. We retrospectively reviewed the charts of 17 patients who suffered from TEN in Farhat Hached University Hospital, Sousse, Tunisia over a 19-year period from January 1994 to January 2013. Causality for suspected drugs was assessed by means of the Naranjo adverse drug reaction (ADR) probability scale. Antibiotics, mainly ß-lactams, were the most common implicated drugs, followed by nonsteroidal anti-inflammatory drugs, anticonvulsants, and allopurinol. The interval between drug intake and onset of the first symptom ranged between few hours and 19 days with a mean period of 6.11 days. There was extensive skin detachment, averaging 66.17% of total body surface area (range 40-95%). The most major complication was infection, occurring in 9 patients (53%). Seven patients died with a mortality rate of 41%

Co-amoxiclav-induced Stevens Johnson Syndrome in a child

Stevens-Johnson Syndrome is an uncommon life threatening disease generally induced by drugs. Antibiotics, mainly sulphonamides, are the most involved drugs in Stevens-Johnson Syndrome in children. Co-amoxiclav is a well tolerated antibiotic. It has never been reported to cause, lonely this syndrome in children. Herein, we report a co-amoxiclav-induced Stevens-Johnson Syndrome occurring in an 18-month-old child. The diagnosis of SJS is often challenging in children and other possible diseases should be ruled out. The etiology of this syndrome is not yet fully understood. It is thought to be mediated by an immunologic mechanism. Management involves early identification, withdrawal of the culprit drug and rapid initiation of supportive therapies.Pan African Medical Journal 2013; 14:3

Acetaminophen-induced cellulitis-like fixed drug eruption

Acetaminophen is a widely used analgesic drug. Its adverse reactions are rare but severe. An 89-year-old man developed an indurated edematous and erythematous plaque on his left arm 1 day after acetaminophen ingestion. Cellulitis was suspected and antibiotictherapy was started but there was no improvement of the rash; there was a spectacular extension of the lesion with occurrence of flaccid vesicles and blisters in the affected sites. The diagnosis of generalized-bullous-fixed drug eruption induced by acetaminophen was considered especially with a reported history of a previous milder reaction occurring in the same site. Acetaminophen was withdrawn and the rash improved significantly. According to the Naranjo probability scale, the eruption experienced by the patient was probably due to acetaminophen. Clinicians should be aware of the ability of acetaminophen to induce fixed drug eruption that may clinically take several aspects and may be misdiagnosed

Vascularite cutanée leucocytoclasique induite par la gabapentine

Nous décrivons le cas d’une patiente ayant développé une vascularite cutanée leucocytoclasique secondaire à la prise de gabapentine

Painful bruising syndrome: A case report

Painful bruising syndrome or Gardner-Diamond syndrome is characterized by an auto erythrocyte sensitization syndrome. We report, here a new case of painful bruising syndrome in a woman with no psychiatric disorders. A 29-year-old female patient presented with complaints of painful bruising over the lower extremities of three years duration. She had a personal history of a severe rheumatoid arthritis. Dermatological examination revealed multiple erythematous, nonedematous and ecchymotic macules over the legs. A psychiatric examination was normal. Complete blood count, prothrombin time and liver function tests were normal. Intracutaneous sensitivity test confirmed Painful bruising syndrome

Pemphigoid gestationis: Report of 44 cases

Introduction: Pemphigoid gestationis (PG) is a rare autoimmune bullous dermatosis occurring during pregnancy and post partum. The aim of our study was to analyse epidemio-clinical, immunopathological, therapeutic and prognostic features of PG through a hospital study of 44 cases. Methods: It is a retrospective study, collecting all cases diagnosed at the dermatological department of Farhat Hached Soussa (Tunisia) from January 1990 to December 2015. Results: The disease began in 40,9% of cases at the second trimester of pregnancy and 48% at the third trimester of pregnancy, one case in post abortum. It was a polymorphic eruption, localized in the chest, the back and limbs in all cases. The face was affected in 18,2% of cases and the mucosa in one case. The skin biopsy showed a subepidermal blister in 25 cases. The direct immunofluoresence found linear C3 deposits along the basement membrane in all cases, associated to IgG deposits in 25% of cases. The treatment was mainly based on local or general corticotherapy with favourable evolution. We noted exacerbation in post partum in 17 cases and relapses during the ulterior pregnancies in 7 cases. Fetal damage was present in PG in 8 cases. Conclusion: Our study is conformed to literature data; nevertheless, it is distinguished by its appearance on the face the less frequency of palmo-plantar manifestations and the exceptional case of PG postabortum

Erysipèle du membre inférieur: étude de 400 cas [Erysipelas of the lower limb: study of 400 cases]

Introduction: Erysipelas is an acute, non-necrotizing dermo-hypodermitis of predominantly streptococcal origin. Objective: To clarify the epidemiological and evolutionary features of the lower limb erysipelas through a hospital series. Materiels and Methods: We retrospectively analyzed all cases of lower limb erysipelas hospitalized in the Department of Dermatology of the Farhat Hached Hospital of Sousse between January 2000 and December 2015 (10 years). Results: Four hundred cases of erysipelas of the lower limb were recorded. The mean age of the patients was 55.82 years. The sex ratio was 1.51. The main predisposing factors were sedentarity, diabetes and obesity. In 96.75% of cases, entry lesion, like mycoses or traumatic injuries was noted. Clinically, a classic presentation of erysipelas was described in all cases. Erysipela was unilateral in 96% of cases. Treatment was based on intravenous penicillin G in 86.5% of cases, on an average of 9.75 days. The evolution was favorable in 83.25% of cases. Antibioprophylaxis was prescribed in 38% of cases. Loco-regional and general complications were noted in 10.25% of cases. Three patients died. Late complications were dominated by relapses and persistence of sequelled lymphedema. RÉSUMÉ Introduction: L’érysipèle est une dermo-hypodermite aigue, non nécrosante, d’origine principalement streptococcique. Objectif: préciser les particularités épidémio-cliniques et évolutives de l’Erysipèle du membre inferieur à travers une série hospitalière. Matériel et Méthodes: Nous avons rétrospectivement analysé tous les cas d’érysipèle du membre inférieur hospitalisés dans le service de dermatologie de l’hôpital Farhat Hached de Sousse entre janvier 2000 et décembre 2015 (10 ans). Résultats: Quatre cents cas d’érysipèle du membre inférieur ont été recensés. L’âge moyen des patients était de 55.82 ans. Le sexe ratio était de 1.51. Les principaux facteurs favorisants étaient : la sédentarité, le diabète et la surcharge pondérale. Une porte d’entrée à type d’intertrigo interorteil ou de plaie traumatique était notée dans 96.75% des cas. Cliniquement, un tableau typique d’érysipèle était décrit dans tous les cas. L’atteinte était unilatérale dans 96% des cas. Le traitement était à base de pénicilline G par voie intraveineuse dans 86,5% des cas pendant en moyenne 9.75 jours. L’évolution était favorable dans 83.25% des cas. Une antibioprophylaxie était prescrite chez 38% des cas. Les complications loco-régionales et générales précoces étaient notées dans 10.25% des cas. Trois patients étaient décedés. Les complications tardives étaient dominées par les récidives et la persistance d’un lymphoedème séquellaire