Mycetomas in central Tunisia

INTRODUCTION: Mycetomas are inflammatory pseudo-tumors containing fungal or actinomycosic-type grains. They are frequent in tropical and subtropical countries and unknown in Tunisia. PATIENTS AND METHODS: We conducted a retrospective study of 12 cases of mycetoma registered in the Dermatological department of the university hospital in Sousse (central Tunisia) over a period of 27 years, from 1974 to 2001. The diagnosis was confirmed by anatomopathological and/or mycological examination. RESULTS: The mean age at the onset was of 49 years and the sex ratio of 1. A notion of a traumatism was reported in two cases and eight patients had various agricultural activities. The mean duration of progression was of eight years. The localization was the foot in 10 cases. The mycetoma was of actinomycosic origin in 10 cases, due to Actinomadura madurae in nine cases, to Nocardia spp in one case and of fungal origin in 2 cases:Pseudoallescheria boydii in one case and Madurella mycetomi in the other. Antibiotic therapy was associated with surgical exeresis in nine cases and amputation in the other two cases. COMMENTS: Confrontation of our results with those of Tunisian series and a review of the literature, helped to specify the clinico-epidemiological characteristics and progression of mycetoma in Tunisia. These characteristics are: the rareness of the infection, the relative frequency of affection in women, the proximal involvement of the foot, the frequency of agricultural activity and the rareness of traumatic past history, the predominance of the actinomycosic origin due to Actinomadura madurae, and the need to associate surgical exeresis with the medical treatment or amputation in order to stop the progress of the disease.     

Undifferentiated sebaceous carcinoma: an unusual childhood cancer

Abstract:  Sebaceous carcinoma is an aggressive, adnexal, rare malignant tumor that may arise in ocular or extra-ocular sites. Extraorbital sebaceous carcinoma is exceptional in childhood. We report a 12-year-old boy with an ocular sebaceous carcinoma who was first seen with an asymptomatic firm, cutaneous nodule on the right eyebrow. The tumor developed slowly within 1 year. Histologically, it was an undifferentiated sebaceous carcinoma. The patient had surgery with wide surgical margins. He was alive and free from disease at a follow-up of 34 months. Close follow-up of this tumor is recommended because of the risk of aggressive behavior.     

Epidemiological profile of salivary-glands tumors in a Tunisian teaching hospital

INTRODUCTION: Salivary-glands tumors come in various presentations and the epidemiological data are variable. The aim of this retrospective study was to establish an epidemiological profile of salivary-glands tumors in a Tunisian teaching hospital and to compare it to published data. PATIENTS AND METHODS: The study was made on 76 men and 80 women with a mean age of 43 years (five months to 85 years). Sixty percent of the tumors were parotid lesions, 16% were submandibular and 24% located on minor salivary glands. Eighty-four percent of parotid tumors were benign. Malignant-parotid tumors often affected men over 60 years of age. Most minor salivary-glands tumors were located on the palate. DISCUSSION: Benign salivary-glands tumors, often have a parotid localization affect, more women in the Tunisian population. Contrary to the literature, in our series, malignant tumors were predominant in women.     

Tinea capitis in adults in Tunisia

Objective To determine the pattern of infectious agents causing tinea capitis (TC) in adult patients in adult patients in Tunisia. Methods From January 1990 to December 2005, we retrospectively collected all cases of adult TC, confirmed by the mycological examination. Results Sixty patients (18 male, 42 female) with a mean age of 34.5 years were diagnosed as having adult TC among a total number of 1137 cases of TC (5.27%). Clinical features were polymorphic and diagnosis was made on mycological examination. Culture identified Trichophyton violaceum in 36 cases (60%), Microsporum canis in 12 cases (20%), Trichophyton schoenleini in 7 cases (12%), Trichophyton verrucosum in two cases (3.5%), and Trichophyton mentagrophytes and Trichophyton rubrum in one case (each 1.77%). Culture was negative in one case. Treatment consisted of administration of Griseofulvin at the dose of 20–25 mg/kg/d during 6–8 weeks associated with antifungal topics. A complete recovery was noted in 55 cases and relapse occurred in two patients. A scary alopecia was observed in one patient and two patients were lost to follow‐up. Conclusion Trichophyton violaceum remains the most common etiological agent of adult TC in Tunisia. Microsporum canis is rising rapidly most notably due to the high frequency of asymptomatic carriage by domestic animals.     

Synovial cyst of the temporomandibular joint

OBSERVATION: A 30-year-old patient presented with a left painful pre-auricular tumefaction for one year. CT-scan suggested the diagnosis of temporomandibular synovial cyst or first branchial cleft cyst. This was confirmed by surgery. DISCUSSION: Temporomandibular synovial cysts are rare, the etiology is not documented. Revealing symptoms are those mentioned above. The common treatment is surgery.     

Netherton's syndrome: the importance of eyebrow hair

Netherton's syndrome (NS) is a rare autosomal recessive disease associated with variable expressions: congenital ichthyosiform erythroderma, ichthyosis linearis circumflexa, specific hair shaft defects (trichorrhexis invaginata) and atopic diathesis. We report the case of 14-year-old non-identical twins whose diagnosis of NS was established on light microscopy of eyebrow hairs. The sisters consulted for a severe episode of atopic dermatitis. Skin examination revealed an ichthyosiform eruption with generalized, polycyclic erythematous plaques with fine double-edged scaling. The flexural creases were lichenified and multiple eczematoid patches were noted. Blood investigation revealed eosinophilia and high IgE level. Microscopy of scalp hair of the twins was repeatedly normal, but the one of the eyebrows revealed typical trichorrhexis invaginata. The presence of trichorrhexis invaginata is necessary to make the diagnosis of NS, but its identification can be difficult because this defect is variable in time and localization. The examination of eyebrow hairs is especially beneficial for patients first seen in late childhood and adults.