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Pérez-Noriega FA, Salinas-Lara C, Sánchez-Garibay C, Torres-Ruíz JJ, Maravillas-Montero JL, Castañón-Arreola M, Hernández-Campos ME, Rodríguez-Balderas C, Basurto-López BV, Peñafiel-Salgado C, Espinosa-García AP, Choreño-Parra JA, Tena-Suck ML, Soto-Rojas LO, León-Marroquín EY, Romero-López JP, Castillejos-López M. Mycobacterium tuberculosis Cell Wall Antigens Induce the Formation of Immune Complexes and the Development of Vasculitis in an Experimental Murine Model. Int J Mol Sci 2023; 24:ijms24021242. [PMID: 36674759 PMCID: PMC9866931 DOI: 10.3390/ijms24021242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Revised: 12/28/2022] [Accepted: 01/05/2023] [Indexed: 01/11/2023] Open
Abstract
Tuberculosis (TB) of the central nervous system (CNS) presents high mortality due to brain damage and inflammation events. The formation and deposition of immune complexes (ICs) in the brain microvasculature during Mycobacterium tuberculosis (Mtb) infection are crucial for its pathobiology. The relevance of ICs to Mtb antigens in the pathogenesis of CNS-TB has been poorly explored. Here, we aimed to establish a murine experimental model of ICs-mediated brain vasculitis induced by cell wall antigens of Mtb. We administered a cell wall extract of the prototype pathogenic Mtb strain H37Rv to male BALB/c mice by subcutaneous and intravenous routes. Serum concentration and deposition of ICs onto blood vessels were determined by polyethylene glycol precipitation, ELISA, and immunofluorescence. Histopathological changes in the brain, lung, spleen, liver, and kidney were evaluated by hematoxylin and eosin staining. Our results evidenced that vasculitis developed in the studied tissues. High serum levels of ICs and vascular deposition were evident in the brain, lung, and kidneys early after the last cell wall antigen administration. Cell wall Mtb antigens induce strong type III hypersensitivity reactions and the development of systemic vasculitis with brain vascular changes and meningitis, supporting a role for ICs in the pathogenesis of TB.
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Affiliation(s)
- Flaubert Alexis Pérez-Noriega
- Departamento de Neuropatología, Instituto Nacional de Neurología y Neurocirugía “Manuel Velasco Suarez”, Mexico City 14269, Mexico
- Red MEDICI, Carrera Médico Cirujano, Facultad de Estudios Superiores Iztacala, Universidad Nacional Autónoma de México, Tlalnepantla 54090, Mexico
| | - Citlaltepetl Salinas-Lara
- Departamento de Neuropatología, Instituto Nacional de Neurología y Neurocirugía “Manuel Velasco Suarez”, Mexico City 14269, Mexico
- Red MEDICI, Carrera Médico Cirujano, Facultad de Estudios Superiores Iztacala, Universidad Nacional Autónoma de México, Tlalnepantla 54090, Mexico
- Tuberculosis Research Commonwealth, Mexico City 14269, Mexico
- Laboratorio de Patogénesis Molecular, Laboratorio 4, Edificio A4, Carrera Médico Cirujano, Facultad de Estudios Superiores Iztacala, Universidad Nacional Autónoma de México, Tlalnepantla 54090, Mexico
- Correspondence: (C.S.-L.); or (C.S.-G.); Tel.: +52-55-5606-3822 (C.S.-L. & C.S.-G.)
| | - Carlos Sánchez-Garibay
- Departamento de Neuropatología, Instituto Nacional de Neurología y Neurocirugía “Manuel Velasco Suarez”, Mexico City 14269, Mexico
- Tuberculosis Research Commonwealth, Mexico City 14269, Mexico
- Correspondence: (C.S.-L.); or (C.S.-G.); Tel.: +52-55-5606-3822 (C.S.-L. & C.S.-G.)
| | - José Jiram Torres-Ruíz
- Departamento de Inmunología y Reumatología, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City 14080, Mexico
| | - José Luis Maravillas-Montero
- Red de Apoyo a la Investigación, Coordinación de Investigación Científica, Universidad Nacional Autónoma de México, e Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City 04510, Mexico
| | | | - María Elena Hernández-Campos
- Escuela Superior de Medicina, Sección de Estudios de Postgrado, Instituto Politécnico Nacional, México City 11340, Mexico
| | - Cesar Rodríguez-Balderas
- Departamento de Bioterio, Instituto Nacional de Neurología y Neurocirugía “Manuel Velasco Suarez”, Mexico City 14269, Mexico
| | - Beatriz Victoria Basurto-López
- Departamento de Neuropatología, Instituto Nacional de Neurología y Neurocirugía “Manuel Velasco Suarez”, Mexico City 14269, Mexico
- Red MEDICI, Carrera Médico Cirujano, Facultad de Estudios Superiores Iztacala, Universidad Nacional Autónoma de México, Tlalnepantla 54090, Mexico
| | - Carlos Peñafiel-Salgado
- Departamento de Neuropatología, Instituto Nacional de Neurología y Neurocirugía “Manuel Velasco Suarez”, Mexico City 14269, Mexico
- Red MEDICI, Carrera Médico Cirujano, Facultad de Estudios Superiores Iztacala, Universidad Nacional Autónoma de México, Tlalnepantla 54090, Mexico
| | - Ana Paola Espinosa-García
- Departamento de Neuropatología, Instituto Nacional de Neurología y Neurocirugía “Manuel Velasco Suarez”, Mexico City 14269, Mexico
- Red MEDICI, Carrera Médico Cirujano, Facultad de Estudios Superiores Iztacala, Universidad Nacional Autónoma de México, Tlalnepantla 54090, Mexico
| | - José Alberto Choreño-Parra
- Tuberculosis Research Commonwealth, Mexico City 14269, Mexico
- Laboratory of Immunobiology and Genetics, Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas, Mexico City 14080, Mexico
| | - Martha Lilia Tena-Suck
- Departamento de Neuropatología, Instituto Nacional de Neurología y Neurocirugía “Manuel Velasco Suarez”, Mexico City 14269, Mexico
| | - Luis O. Soto-Rojas
- Red MEDICI, Carrera Médico Cirujano, Facultad de Estudios Superiores Iztacala, Universidad Nacional Autónoma de México, Tlalnepantla 54090, Mexico
- Laboratorio de Patogénesis Molecular, Laboratorio 4, Edificio A4, Carrera Médico Cirujano, Facultad de Estudios Superiores Iztacala, Universidad Nacional Autónoma de México, Tlalnepantla 54090, Mexico
| | - Elsa Y. León-Marroquín
- Tuberculosis Research Commonwealth, Mexico City 14269, Mexico
- Departamento de Física Médica, Hospital De Oncología, Centro Médico Nacional Siglo XXI, Instituto Méxicano del Seguro Social, Mexico City 06720, Mexico
| | - José Pablo Romero-López
- Red MEDICI, Carrera Médico Cirujano, Facultad de Estudios Superiores Iztacala, Universidad Nacional Autónoma de México, Tlalnepantla 54090, Mexico
- Laboratorio de Patogénesis Molecular, Laboratorio 4, Edificio A4, Carrera Médico Cirujano, Facultad de Estudios Superiores Iztacala, Universidad Nacional Autónoma de México, Tlalnepantla 54090, Mexico
| | - Manuel Castillejos-López
- Tuberculosis Research Commonwealth, Mexico City 14269, Mexico
- Departamento de Epidemiología Hospitalaria e Infectología, Instituto Nacional de Enfermedades Respiratorias Ismael Cosio Villegas, Mexico City 14080, Mexico
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Almasoudi AA, Bablghaith ES, Alaauldeen SI, M Falemban A, Sherbeeni AA, Bulkhi AA. Ceftriaxone-induced leukocytoclastic vasculitis: a case report and literature review of antibiotic-induced leukocytoclastic vasculitis. J Int Med Res 2022; 50:3000605221097768. [PMID: 35587703 PMCID: PMC9127858 DOI: 10.1177/03000605221097768] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Leukocytoclastic vasculitis (hypersensitivity vasculitis) is defined as small blood vessel inflammation with skin or other systemic manifestations due to infections, drugs, or neoplastic disease. This clinical case report highlights an association between ceftriaxone and leukocytoclastic vasculitis in a 49-year-old female patient with a history of penicillin allergy, on mirtazapine for anxiety disorder. Articles concerning antibiotic-induced leukocytoclastic vasculitis are also reviewed. The patient reported a symptom of upper respiratory tract infection and fever 5 days previously for which she received ceftriaxone for 2 days before presenting to the emergency department with a pruritic skin rash in the upper and lower extremities and swollen lips for 1 day. The rash was erythematous, maculopapular, itchy, and non-tender, with no mucus membrane involvement. Laboratory investigations revealed leukocytosis (white blood cells, 22.3 × 109/L) that was mainly eosinophilic (18.4%). The patient was administered prednisolone and antihistamine after stopping ceftriaxone empirically. A skin biopsy confirmed the diagnosis of leukocytoclastic vasculitis. Significant clinical improvement was observed after treatment initiation. Upon follow-up, the skin rash was resolved entirely with no scars; however, there was skin-peeling over the lower extremities. Recognition of antibiotic-induced leukocytoclastic vasculitis is crucial as many classes of antibiotics can contribute to this condition. Continuation of the offending drug may lead to life-threatening complications.
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Affiliation(s)
- Aseel A Almasoudi
- Department of Internal Medicine, King Abdullah Medical City, Makkah, Kingdom of Saudi Arabia
| | - Eman S Bablghaith
- Department of Internal Medicine, King Abdullah Medical City, Makkah, Kingdom of Saudi Arabia
| | - Samaher I Alaauldeen
- Department of Internal Medicine, King Abdullah Medical City, Makkah, Kingdom of Saudi Arabia
| | - Ayman M Falemban
- Department of Internal Medicine, King Abdullah Medical City, Makkah, Kingdom of Saudi Arabia
| | - Ahlam A Sherbeeni
- Department of Internal Medicine, King Abdullah Medical City, Makkah, Kingdom of Saudi Arabia
| | - Adeeb A Bulkhi
- Department of Internal Medicine, King Abdullah Medical City, Makkah, Kingdom of Saudi Arabia.,Department of Internal Medicine, College of Medicine, Umm Al-Qura University, Makkah, Kingdom of Saudi Arabia
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Yamauchi N, Tanda S, Kashiwagi S, Ohnishi A, Kugai M, Akazawa T, Matsumoto T, Yamauchi J, Muramatsu A, Fujimoto S. Fatal gastrointestinal bleeding due to IgA vasculitis complicated with tuberculous lymphadenitis: A case report and literature review. Clin Case Rep 2020; 8:1741-1747. [PMID: 32983488 PMCID: PMC7495800 DOI: 10.1002/ccr3.2938] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2019] [Revised: 03/28/2020] [Accepted: 04/25/2020] [Indexed: 01/24/2023] Open
Abstract
We report a case of IgA vasculitis that developed during the treatment of tuberculosis. Patients with tuberculosis who are on antituberculosis treatment can be administered steroids for severe disease or complications.
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Affiliation(s)
| | - Shuji Tanda
- Department of NephrologyAkashi City HospitalAkashiJapan
| | - Saori Kashiwagi
- Department of GastroenterologyAkashi City HospitalAkashiJapan
| | | | - Munehiro Kugai
- Department of GastroenterologyAkashi City HospitalAkashiJapan
| | - Takako Akazawa
- Department of GastroenterologyAkashi City HospitalAkashiJapan
| | | | - Junko Yamauchi
- Department of GastroenterologyAkashi City HospitalAkashiJapan
| | - Akira Muramatsu
- Department of GastroenterologyAkashi City HospitalAkashiJapan
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Çetinarslan T, Türel Ermertcan A, Aydoğdu İ, Temiz P. A rare vasculitis type in a patient with acute myeloblastic leukemia: Annular leukocytoclastic vasculitis as a paraneoplastic syndrome? Dermatol Ther 2020; 33:e14080. [PMID: 32713103 DOI: 10.1111/dth.14080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 07/21/2020] [Accepted: 07/22/2020] [Indexed: 11/28/2022]
Affiliation(s)
| | - Aylin Türel Ermertcan
- Medical Faculty, Department of Dermatology, Manisa Celal Bayar University, Manisa, Turkey
| | - İsmet Aydoğdu
- Medical Faculty, Department of Hematology, Manisa Celal Bayar University, Manisa, Turkey
| | - Peyker Temiz
- Medical Faculty, Department of Pathology, Manisa Celal Bayar University, Manisa, Turkey
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Abstract
We have explored the rash that appears as target lesions, with the central and dominant diseases belonging to the Stevens-Johnson syndrome/toxic epidermal necrolysis group. After presenting the clinical patterns of an individual target lesion and classifying them into different types of lesions, the contribution has been organized with groups characterized by such specific findings according to the type of lesion: flat or raised, typical or atypical, presence or absence of fever, presence or absence of mucosal ulcerations, presence or absence of arthralgias, and/or internal organ involvement. Other specific features, such as histologic appearance, immunofluorescence findings, and laboratory changes, are considered. We provide clinicians with an algorithmic, systematic, and logical approach to diagnose the condition of the patients who present with targetoid lesions, and enable them to differentiate between those with serious systemic and life-threatening diseases from others with ordinary skin ailments.
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Affiliation(s)
- Ronni Wolf
- The School of Medicine, Hebrew University, Jerusalem, Israel; Hadassah Medical Center, Jerusalem, Israel.
| | - Jennifer L Parish
- Department of Dermatology and Cutaneous Biology, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania, USA; Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - Lawrence Charles Parish
- Department of Dermatology and Cutaneous Biology, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania, USA
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Lava SAG, Milani GP, Fossali EF, Simonetti GD, Agostoni C, Bianchetti MG. Cutaneous Manifestations of Small-Vessel Leukocytoclastic Vasculitides in Childhood. Clin Rev Allergy Immunol 2018; 53:439-451. [PMID: 28836099 DOI: 10.1007/s12016-017-8626-3] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
In childhood, cutaneous small-vessel vasculitides include Henoch-Schönlein syndrome, a systemic vasculitis, and Finkelstein-Seidlmayer syndrome, a skin-limited vasculitis. Both Henoch-Schönlein and Finkelstein-Seidlmayer syndromes are seen more frequently in white or Asian compared with black children and occur especially in winter and spring with a male-to-female ratio of approximately 2:1. In everyday clinical practice, both conditions are diagnosed on clinical grounds without histological confirmation. The characteristic cutaneous hallmarks of Henoch-Schönlein syndrome include a purpuric rash in all and a subcutaneous edema in approximately every second case, which are often preceded by non-specific red or pink macular elements that mimic a non-itching urticarial rash. Recent data point out that Henoch-Schönlein children often present further cutaneous findings such as Köbnerization, Rumpel-Leede capillary fragility phenomenon, and blistering eruptions. Children with Finkelstein-Seidlmayer syndrome are usually ≤24 months of age and not ill-appearing. They present with (a) large, round, red to purpuric plaques (often with a targetoid appearance) predominantly over the cheeks, ears, and extremities and (b) often tender non-pitting edema of the distal extremities, ears, and face (without pruritus). Both in Henoch-Schönlein syndrome and Finkelstein-Seidlmayer syndrome, there is often scrotal involvement. The cutaneous findings remit without sequelae within 2 months in Henoch-Schönlein and 3 weeks in Finkelstein-Seidlmayer syndrome.
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Affiliation(s)
- Sebastiano A G Lava
- Department of Pediatrics, University Children's Hospital of Bern, Inselspital, Bern, Switzerland
| | - Gregorio P Milani
- Pediatric Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico and Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy
| | - Emilio F Fossali
- Pediatric Emergency Department, Università degli Studi di Milano, Foundation IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Giacomo D Simonetti
- Pediatric Department of Southern Switzerland, San Giovanni Hospital, 6500, Bellinzona, Switzerland
- Università della Svizzera Italiana, Lugano, Switzerland
| | - Carlo Agostoni
- Pediatric Intermediate Care Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico and Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy
| | - Mario G Bianchetti
- Pediatric Department of Southern Switzerland, San Giovanni Hospital, 6500, Bellinzona, Switzerland.
- Università della Svizzera Italiana, Lugano, Switzerland.
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Moawad S, Bursztejn AC, Schmutz JL, Barbaud A. [Annular leukocytoclastic vasculitis: A particular form of small vessel vasculitis?]. Ann Dermatol Venereol 2016; 143:364-8. [PMID: 27080819 DOI: 10.1016/j.annder.2016.02.025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2015] [Revised: 12/22/2015] [Accepted: 02/24/2016] [Indexed: 11/29/2022]
Abstract
BACKGROUND Leukocytoclastic vasculitis is characterized by necrotizing inflammation around small blood vessels, composed mainly of neutrophils. Skin lesions in leukocytoclastic vasculitis are polymorphous, but a rare annular variant exists of which dermatologists must be aware. Herein we present a new case of this entity. PATIENTS AND METHODS We report the case of a 74-year-old man who developed annular purpuric infiltrated lesions mainly on the lower limbs, with leukocytoclastic vasculitis being confirmed by histology. This annular leukocytoclastic vasculitis regressed spontaneously with no recurrence after 6 months. The aetiology was not established. DISCUSSION Annular leukocytoclastic vasculitis is rare, and the mechanisms underlying annularity and peripheral spread as well as the aetiology remain unexplained. This form of vasculitis with unusual clinical features may constitute a new entity in the subclass of immune complex small vessel vasculitis within the Chapel Hill classification. While the aetiology and physiopathology of this vasculitis are unknown, despite the possibility of recurrence, skin involvement appears isolated and the condition carries a good prognosis.
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Affiliation(s)
- S Moawad
- Pôle des spécialités médicales, service de dermatologie, centre hospitalier universitaire de Nancy, hôpitaux de Brabois, 5, rue du Morvan, 54500 Vandœuvre-lès-Nancy, France.
| | - A-C Bursztejn
- Pôle des spécialités médicales, service de dermatologie, centre hospitalier universitaire de Nancy, hôpitaux de Brabois, 5, rue du Morvan, 54500 Vandœuvre-lès-Nancy, France
| | - J-L Schmutz
- Pôle des spécialités médicales, service de dermatologie, centre hospitalier universitaire de Nancy, hôpitaux de Brabois, 5, rue du Morvan, 54500 Vandœuvre-lès-Nancy, France
| | - A Barbaud
- Pôle des spécialités médicales, service de dermatologie, centre hospitalier universitaire de Nancy, hôpitaux de Brabois, 5, rue du Morvan, 54500 Vandœuvre-lès-Nancy, France
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Avcu G, Sensoy G, Çeliksoy MH, Sogut A, Kefeli M, Karli A, Belet N. Cutaneous leukocytoclastic vasculitis associated with anti-tuberculosis drugs. Pediatr Int 2015; 57:155-7. [PMID: 25711253 DOI: 10.1111/ped.12403] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2014] [Revised: 04/02/2014] [Accepted: 04/10/2014] [Indexed: 12/16/2022]
Abstract
Leukocytoclastic vasculitis (LCV), a disease characterized by inflammation of the small vessels, presents with palpable purpura, especially in the lower extremities. Its etiology is known to include drugs, infection, collagen tissue disease, and malignancy, but LCV caused by anti-tuberculosis drugs is very rarely seen. This report describes the case of a 12-year-old girl who developed LCV with rifampicin and ethambutol while undergoing anti-tuberculosis treatment due to extensive pulmonary involvement.
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Affiliation(s)
- Gülhadiye Avcu
- Department of Pediatric Infectious Disease, Ondokuz Mayıs University, Samsun, Turkey
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Meziane M, Amraoui N, Taoufik H, Mernissi FZ. Cutaneous leukocytoclastic vasculitis revealing multifocal tuberculosis. Int J Mycobacteriol 2013; 2:230-2. [PMID: 26786128 DOI: 10.1016/j.ijmyco.2013.07.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2013] [Accepted: 07/29/2013] [Indexed: 11/28/2022] Open
Abstract
Cutaneous leukocytoclastic vasculitis (CLV) is an inflammatory vascular disorder rarely reported to be associated with tuberculosis. The following report describes the case of a young man with multifocal tuberculosis revealed by CLV. Diagnosis was confirmed by the presence of tuberculoid granuloma with caseous necrosis on pleural and perianal biopsy, and a rapid improvement in anti-tuberculous quadritherapy. Although rarely seen, Mycobacterium tuberculosis should be considered as a potential cause of CLV.
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Affiliation(s)
- Mariame Meziane
- Dermatological Department, Hassan II University Hospital, Fes, Morocco.
| | - Nisrine Amraoui
- Dermatological Department, Hassan II University Hospital, Fes, Morocco
| | - Harmouch Taoufik
- Laboratory of Pathology, Hassan II University Hospital, Fes, Morocco
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