Primary and isolated cutaneous precursor B-lymphoblastic lymphoma in an infant

Cutaneous lesions may represent the initial sign of various neoplasms in children, including histiocytosis, neuroblastomas, and lymphomas. Primary cutaneous lymphoblastic lymphomas are rare and involve mostly the B-cell phenotype. Herein, we report a case of isolated, primary B-lymphoblastic lymphoma in a 7-month-old infant and emphasize the importance of early diagnosis.

Uncommon Nail Involvement during Bullous Pemphigoid

Bullous pemphigoid (BP) is the most frequent autoimmune blistering disorder. The immune reaction targets BP180 and BP230 antigens, 2 components of junctional adhesion complexes at the basement membrane zone. Clinical aspect includes multiple tense bullae on urticarial plaques of the skin. Although the nail apparatus may be affected by the immune process, nail changes have been rarely reported during BP. We report a case of a 72-year-old woman diagnosed with BP who subsequently developed a secondary nail loss of the 2 thumbs and the left middle finger. Also, she presented onycholysis of the fourth left finger with the aspect of roller-coaster of the proximal border at dermoscopy. Steroid therapy at high doses was ineffective and the nail atrophy was permanent.

Climate sensitivity of milk production traits and milk fatty acids in genotyped Holstein dairy cows

The aim of this study was the evaluation of climate sensitivity via genomic reaction norm models [i.e., to infer cow milk production and milk fatty acid (FA) responses on temperature-humidity index (THI) alterations]. Test-day milk traits were recorded between 2010 and 2016 from 5,257 first-lactation genotyped Holstein dairy cows. The cows were kept in 16 large-scale cooperator herds, being daughters of 344 genotyped sires. The longitudinal data consisted of 47,789 test-day records for the production traits milk yield (MY), fat yield (FY), and protein yield (PY), and of 20,742 test-day records for 6 FA including C16:0, C18:0, saturated fatty acids (SFA), unsaturated fatty acids (UFA), monounsaturated fatty acids (MUFA), and polyunsaturated fatty acids (PUFA). After quality control of the genotypic data, 41,057 SNP markers remained for genomic analyses. Meteorological data from the weather station in closest herd distance were used for the calculation of maximum hourly daily THI. Genomic reaction norm models were applied to estimate genetic parameters in a single-step approach for production traits and FA in dependency of THI at different lactation stages, and to evaluate the model stability. In a first evaluation strategy (New_sire), all phenotypic records from daughters of genotyped sires born after 2010 were masked, to mimic a validation population. In the second strategy (New_env), only daughter records of the new sires recorded in the most extreme THI classes were masked, aiming at predicting sire genomic estimated breeding values (GEBV) under heat stress conditions. Model stability was the correlation between GEBV of the new sires in the reduced data set with respective GEBV estimated from all phenotypic data. Among all test-day production traits, PY responded as the most sensitive to heat stress. As observed for the remaining production traits, genetic variances were quite stable across THI, but genetic correlations between PY from temperate climates with PY from extreme THI classes dropped to 0.68. Genetic variances in dependency of THI were very similar for C16:0 and SFA, indicating marginal climatic sensitivity. In the early lactation stage, genetic variances for C18:0, MUFA, PUFA, and UFA were significantly larger in the extreme THI classes compared with the estimates under thermoneutral conditions. For C18:0 and MUFA, PUFA, and UFA in the middle THI classes, genetic correlations in same traits from the early and the later lactation stages were lower than 0.50, indicating strong days in milk influence. Interestingly, within lactation stages, genetic correlations for C18:0 and UFA recorded at low and high THI were quite large, indicating similar genetic mechanisms under stress conditions. The model stability was improved when applying the New_env instead of New_sire strategy, especially for FA in the first stage of lactation. Results indicate moderately accurate genomic predictions for milk traits in extreme THI classes when considering phenotypic data from a broad range of remaining THI. Phenotypically, thermal stress conditions contributed to an increase of UFA, suggesting value as a heat stress biomarker. Furthermore, the quite large genetic variances for UFA at high THI suggest the consideration of UFA in selection strategies for improved heat stress resistance.

Assessment of Incubation Period of Cutaneous Leishmaniasis due to Leishmania major in Tunisia

The period between the infective sandfly bites and appearance of cutaneous leishmaniasis (CL) lesions is still hypothetical and little studied. This work aimed at assessing the incubation time of zoonotic CL (ZCL) due to Leishmania major using a standardized methodology. The retrospective analysis used the epidemiological, clinical, and biological information available in the database recording all the CL cases diagnosed at the Parasitology Department of the Pasteur Institute of Tunis during 2015-2019. It allowed for the selection of 92 privileged observations 1) of confirmed CL cases with presentation suggestive of ZCL form 2) living in northern regions free of ZCL 3) with a single infective trip of less than a week to ZCL foci during transmission season and 4) with accurate dates of travel and onset of lesions. Incubation length computed in this population ranged from 1 to 21 weeks, with a median of 5 weeks (interquartile range: 3-8.5 weeks).

Unexpected diagnosis of basal cell carcinoma in a patient presenting with a secondary location of Leishmania parasites in the skin

We report here a case of simultaneous cutaneous and visceral manifestations due to Leishmania L. infantum diagnosed in an immunocompetent adult. We describe a 74-year-old woman from Tunis, Tunisia, who presented a biologically confirmed visceral leishmaniasis infection concomitant with arm ulceration which appeared 2 years before. Leishmania DNA was detected by ITS PCR in both buffy coat and dermal scrapping of the arm lesion. Sequencing revealed that the 2 isolated strains corresponded to L. infantum and were 100% identical. The symptoms of visceral leishmaniasis responded to amphotericin B with rapid healing. However, the skin lesion did not improve although Leishmania PCR on dermal sample became negative. This location is probably secondarily to lymphatic or blood dissemination during the systemic visceral leishmaniasis infection. It would be favored by the inflammatory environment induced by the basal cell carcinoma subsequently diagnosed.

Genital Involvement in Bullous Fixed Drug Eruption

Bullous fixed drug eruption (FDE) is a severe reaction due to drug intake and requires specific management in dermatology. The sites of predilection are the lips, trunk, genitalia, and perineal area. The aim of our study was to assess the features and outcomes of bullous FDE with genital involvement through a retrospective study of 18 years (2000-2017) conducted in the Dermatology Department of Habib Thameur Hospital. Ten patients were included in the study. The ratio of men to women was 6.4. The mean age of the patients was 46.3 years. The most frequently affected genital site in men was the glans penis. Nonsteroidal anti-inflammatory drugs were the most frequent drugs associated with genital bullous FDE, followed by paracetamol and trimethoprim-sulfamethoxazole. Residual hyperpigmentation of the genitals was not observed in our patients. Genital involvement in bullous FDE is more frequent in men.