Clinical implications and prognostic significance of thrombocytopenia in Tunisian patients with systemic lupus erythematosus

Objective: The objective of this study was to determine the role of thrombocytopenia in terms of disease manifestations, disease activity and prognostic impact in a cohort of Tunisian systemic lupus erythematosus (SLE) patients. Methods: The charts of 182 SLE patients diagnosed between 1996 and 2009 were retrospectively reviewed. The clinical manifestations, immunological profiles, disease activity, SLE relapses and survival rate at the time of follow-up were recorded. Results: Thrombocytopenia (<100,000/mm3) and severe thrombocytopenia (<20,000/mm3) was observed in 19.2% and 4.4%, respectively. Hemorrhagic manifestations were observed in 11 patients (31.4%). Thrombocytopenia was significantly associated with splenomegaly, renal disorders, neurologic manifestations, arterial thrombosis, leucopenia, low C3 level at SLE diagnosis, SLE relapses and infectious complications. Using multivariate logistic regression, thrombocytopenia was independently associated with splenomegaly (odds ratio [OR] = 9.36, p = 0.001), neurologic manifestations (OR = 4.6, p = 0.006) and renal disease (OR = 4.15, p = 0.02). By multivariable Cox proportional hazard regression analyses, thrombocytopenia was associated with the occurrence of mortality after adjusting for variables known to influence it (hazard ratio [HR] = 1.79, p = 0.045). The cause of death was unrelated to hemorrhagic complications in all patients. Conclusion: Our results, concerning North-African SLE patients, confirm the findings of previous studies which suggest that thrombocytopenia correlates with more severe disease and has a negative impact on the survival of lupus patients.

Pilomatrixoma of earlobe

Pilomatrixomas are uncommon in children and are frequently misdiagnosed preoperatively. We report a two-year-old female patient with an unusual localization in the earlobe. The lesion was treated by simple enucleation and in two years of follow-up there has been no evidence of recurrence. The case is being reported in view of its rarity and unusual location.

Iatrogenic neonatal bladder perforation

Neonatal bladder rupture is rare as a complication of bladder obstruction due to abnormal anatomy or iatrogenic causes. The present study describes the case of a 3-day-old infant with ascites due to bladder perforation secondary probably to manual decompression of the bladder. The infant underwent successful surgical repair of the perforation.

Neonatal ovarian lymphangioma

Ovarian cysts are primarily of follicular origin and ovarian lymphangioma is an extremely rare lesion. We report a case of prenatal diagnosis of unilateral ovarian cyst in which pathologic examination revealed an ovarian lymphangioma. Ovarian cystic lymphangioma should be included in the differential diagnosis of an ovarian cyst mass in neonate.

Congenital penile masses

A 2-month-old boy was referred to our department for evaluation of a double mass on the ventral aspect of the penile shaft. There were no associated signs or symptoms of urologic dysfunction. The patient underwent circumcision with complete resection of the masses under general anesthesia.