Metastatic Adenocarcinoma of the Lung Presenting as a Presternal Cutaneous Mass: Case Report and Brief Literature Review

BACKGROUND

Cutaneous metastases from lung cancer are uncommon; they can be the presenting sign of an unknown malignancy.

CASE REPORT

We present a 53-year-old man with a presternal mass that proved to be a cutaneous metastasis revealing an underlying lung adenocarcinoma. We searched the relevant literature and present a review of the main clinical and pathological features of this type of cutaneous metastasis.

CONCLUSION

Skin metastases are a rare manifestation of an underlying lung cancer, of which they can be the initial manifestation. Recognition of these metastases is important to promptly introduce an appropriate treatment.

Mortality and prognostic factors of Bullous Pemphigoid in a Moroccan population

BACKGROUND

Bullous pemphigoid is a common autoimmune blistering skin disease that is significantly associated with a high rate of morbidity and mortality.

OBJECTIVE

Our aim was to determine the 1-, 2- and 3-year mortality rate and standardized mortality ratio of BP in Moroccan patients, as well as to identify risk factors that influence survival both in the 1st and 3rd year of follow-up.

METHODS

All patients with BP diagnosed between January 2008 and December 2017 in a tertiary referral centre at the Mohammed V Military Hospital in Morocco were included retrospectively.

RESULTS

The 1-year, 2-year and 3-year mortality rates of the cases were 25.8%, 32.3% and 43%, respectively. The median age of onset was 72 years (range, 64 ∼ 80 years), and 51 (54.8%) patients were men. The standardized mortality ratio of patients with BP was 2.6 times higher than that of age- and sex-matched members of the general Moroccan population. Besides advanced age, the presence of diabetes mellitus at the time of diagnosis was associated with increased 3-year mortality in multivariate analysis.

CONCLUSION

This is the first study analysing the mortality rate of bullous pemphigoid in Morocco. Our findings confirm a high mortality rate for BP patients compared with the expected mortality rate for age- and sex-adjusted general Moroccan population. Risk factors for increased 3-year mortality include advanced age at the time of diagnosis and diabetes mellitus.

The association between bullous pemphigoid and comorbidities: a case-control study in Moroccan patients

BACKGROUND

Comorbidities of bullous pemphigoid (BP) have not been thoroughly described in Morocco. This study investigates clinical features, comorbidities, and medications in a cohort of Moroccan patients with confirmed BP to help decrease morbidity and mortality.

MATERIAL AND METHODS

This cross-sectional study involved 81 cases of BP diagnosed in 2015-2018 and 162 age- and sex-matched controls with complete follow-up at the Department of Dermatology in a university hospital setting.

RESULTS

Eighty-one individuals were included in the study; the mean age at diagnosis was 71.3 years, and 53% were men. The most common comorbidities were hypertension (58%), type 2 diabetes (43%), and dyslipidemia (31%). Almost a quarter of the cohort (28%) had been diagnosed with at least one neurological disease before the onset of BP. BP was significantly associated with the presence of malignancies (14%; p = 0.017) and stroke (16%; p = 0.009) compared to an age-matched control group. The most common standard medications were beta-blockers, diuretics, and statins. In total, 86% of the patients with type 2 diabetes were taking antidiabetic drugs, especially metformin (82%) and gliptins (51%).

CONCLUSION

This study showed that BP is associated with stroke and the presence of malignancy compared to the age-matched general population. This study also calls for investigation into the specific role of some drugs as inducing factors for BP.

Multimorbidity among persons living with human immunodeficiency virus in a moroccan referral hospital

Background

Multimorbidity is the co-existing of two or more chronic health conditions in addition to human immunodeficiency virus (HIV). In Morocco, the prevalence of and factors associated with multimorbidity in HIV-infected patients have not been well-documented.

Methods

This cross-sectional analysis was conducted in 2018 and included 269 HIV-infected patients. Medical records were reviewed to identify chronic health conditions and to rate multimorbidity using the Cumulative Illness Rating Scale (CIRS). Associations between a higher CIRS score and risk factors were assessed using linear regression.

Results

The mean age was 48.9 ± 10.7 years with a male predominance (75.5%). One in 5 (20,8%) had ever been diagnosed with acquired immunodeficiency syndrome. More than a 3^rd (34.8%) of the patients had two or more chronic health conditions in addition to HIV. The most frequently documented comorbidities were metabolic complications followed by vascular disease. In multivariate analysis, older age, male gender, duration of receiving antiretroviral therapy, taking indinavir-containing antiretroviral regimen, having ever been stage Centers for Disease Control and Prevention B or C, and current viral load ≥50 copies mL^-1 were associated with a higher CIRS score.

Conclusion

The prevalence of comorbidities is substantially high. Care models for people living with HIV should include assessing and managing multimorbidity, particularly in patients who present with these associated factors.

Pseudo-Hyperchloremia: Think about Analytical Interference with Bromides

BACKGROUND

We report a case of pseudo-hyperchloremia in a patient hospitalized in the dermatology department at the Mohammed V Military Hospital of Instruction in Rabat. The examination revealed self-medication with calcium bromo-galactogluconate, allowing the suspicion of an analytical interference on chloremia by bromides.

METHODS

The determination of chloremia was done by indirect potentiometry on an Architect ci8200®.

RESULTS

A biological assessment was carried out on admission, showed isolated hyperchloremia at 137 mmol/L (95 - 110 mmol/L), while the other electrolytes, the anion gap, and kidney function were normal. A follow-up electrolytes test one week after stopping calcium bromo-galactogluconate showed normalization of chloremia to 109 mmol/L.

CONCLUSIONS

The analytical interference of bromides on the chloride assay causes pseudo-hyperchloremia, an analytical anomaly not very well-known by clinicians.

The dilemma of treating pyoderma gangrenosum associated with monoclonal gammopathy of undetermined significance

Pyoderma gangrenosum (PG) is a rare ulcerative skin condition. It can be associated with a number of systemic diseases. Association with monoclonal gammopathy of undetermined significance (MGUS) is uncommon, but prognosis may be different depending upon the type of MGUS. Cases of MGUS- related PG reported in the literature with data concerning evolution and treatment were identified through a PubMed search. A patient with recurrent PG in the setting of a MGUS-IgA-? in our department was also included. In total, 10 cases were identified. Only the two cases with Ig populations other than IgA improved without recurrence after treatment of the PG. All the patients with MGUS-IgA showed recurrences. Early multiple myeloma was proposed for three patients with MGUS-IgA-related PG. Second or third line treatments were necessary in some cases.

Predictive factors for relapse in adults with dermatomyositis

INTRODUCTION

Dermatomyositis (DM) is a severe disease that can be chronic with relapses and severe morbidity. The objective of this study was to analyze clinical features at presentation that predict non-paraneoplastic DM relapse in adult patients.

METHODS

A multicenter retrospective study focused on 33 patients diagnosed with DM and treated using corticosteroids from 2000 to 2015. This study also aimed to compare patients with and without relapse based on some predictive factors such as demographic characteristics and clinical symptoms. A Cox model was used to estimate hazard ratios (HRs).

RESULTS

We identified 33 patients with an average age of 41.8 ± 12 years (range 18-68 years). The sex ratio of females to males was 2:1. During the 13.5-month follow-up period, two (6%) patients died and 21 (63.6%) suffered from a relapse. In univariate analysis, skin ulceration in the initial presentation of disease (HR = 3.1, range 1.1 to 15.1) was significantly associated with a relapsing course.

CONCLUSIONS

This study demonstrates that in the initial presentation of the disease skin ulceration is significant in allowing prediction of the occurrence of DM relapse.

Tuberculous gummas: Epidemiological, clinical, bacteriological, immunological, and therapeutic features

Tuberculous gummas are an unusual form of tuberculosis (TB) accounting for 1%-2% of all cutaneous TB cases. The aim of this article was to describe the epidemiological, clinical, bacteriological, immunological, and therapeutic features of this form upon a case report and a literature review. Forty-eight case reports were identified through a PubMed and Google Scholar search using the following keywords: "tuberculous gumma" and "metastatic tuberculous abscesse." Tuberculous gumma can occur at any age. Immunodepression is not a sine qua non condition to the development of the disease. Limbs are the most frequent site for gummas. Tuberculous gummas are associated to another location in only 73% of cases. The most frequent associated locations are lung, nodes, and musculoskeletal apparatus. Mantoux test is negative in 38% of cases. Skin stain is positive in 45% of cases and culture in 85% of cases. Giant epithelioid cell granuloma is present in 82.4% of cases. There is no universally accepted chemotherapy regimen for metastatic tuberculous abscesses. The classic 2RHZE/4RH is highly effective.

Radiation-induced morphea: autoimmunity as a risk factor

Radiation-induced morphea (RIM) is a rare complication of radiotherapy of unknown etiology. We report the case of a woman with a history of vitiligo and Hashimoto's thyroiditis, who developed RIM following radiotherapy for breast carcinoma. We suggest that a history of autoimmune disease is a possible risk factor for the development of RIM.

[A rare and atypical cause of scrotal ulcerations]

Salmonelloses are bacterial infections of the faecal peril; they are endemic in some regions of the world. They can colonize almost any organ hematogenously, hence, severe forms may be observed. We report a case of typhoid fever in a 16-year old young adolescent with no medical history, sexually transmitted diseases or sexual intercourses, presenting with necrotic scrotal ulcerations evolving over the past 3 weeks in a context of fever, diarrhoea, weight loss and alteration of the general state. Paraclinical assessment showed 7g/dl hypochromic microcyticanemia with target cells in blood smear and normal hemoglobin electrophoresis, biologic inflammatory syndrome, malabsorption syndrome, cytolysis and hepatic cholestasis 20 times above the normal, hepatosplenomegaly, normal viral serologic testing (HBV, HCV, HIV, EBV and CMV) and positive testing for salmonella. The patient underwent 3 weeks of therapy with fluoroquinolones with favorable evolution. Dermatologic manifestations are frequent and polymorphic in typhoid fever; however cutaneous and, in particular, scrotal ulcerations are rarely reported. Differential diagnosis may be based on sexually transmitted diseases, inflammatory bowel diseases or hematologic disorders. More often diarrhoea is reduced or absent and patient's outcome depends on antibiotic. Diagnostic confirmation in patients with an atypical clinical picture, as in the case of our patient, is based on serology. Treatment is based on proper and prolonged antibiotic therapy and on prophylaxis measures to neighbouring.

Prevalence of resistance to integrase strand-transfer inhibitors (INSTIs) among untreated HIV-1 infected patients in Morocco

Objective

The integrase strand-transfer inhibitors (INSTIs) are an important class in the arsenal of antiretroviral drugs designed to block the integration of HIV-1 cDNA into the host DNA through the inhibition of DNA strand transfer. In this study for the first time in Morocco, the complete HIV-1 integrase gene was analysed from newly diagnosed patients to evaluate the prevalence of natural polymorphisms and INSTIs resistance-associated mutations in the integrase gene.

Results

The 864pb IN coding region was successfully sequenced from plasma sample for 77 among 80 antiretroviral naïve patients. The sequences were interpreted for drug resistance according to the Stanford algorithm. Sixty samples were HIV-1 subtype B (78%), fourteen CRF02_AG (18%), two subtype C and one subtype A. Overall 81 of 288 (28%) amino acid IN positions presented at least one polymorphism each. We found 18 (36.73%), 42 (25.76%) and 21 (27.27%) of polymorphic residues assigned to the N-Terminal Domain, Catalytic Core Domaine and the C-Terminal Domain positions respectively. Primary INSTIs resistance mutation were absent, however secondary mutations L74IM, T97A were detected in four samples (5.2%). These results demonstrate that untreated HIV-1 infected Moroccans will be susceptible to INSTIs.

Electronic supplementary material

The online version of this article (10.1186/s13104-018-3492-5) contains supplementary material, which is available to authorized users.

[Soft tissue melanoma: a clinical case]

Le mélanome des tissus mous a été décrit en 1965 par Enzinger sous le nom de sarcome à cellules claires. En 1983, Chung et Enzinger le rebaptisent mélanome des parties molles en raison de similitudes immunohistochimiques avec le mélanome. Nous rapportons un cas de cette forme rare de mélanome, chez un jeune homme de 22 ans qui avait une lésion molluscoïde de la cheville sans signes cliniques de malignité, et dont l’examen histologique a permis de retenir ce diagnostic.

Dermatologic manifestations among human immunodeficiency virus patients in Morocco and association with immune status

OBJECTIVE

The objective was to determine if the type and number of skin diseases can be clinical indicators of underlying immune status in HIV1 disease by estimating and correlating with the CD4 count and CDC stage.

MATERIALS AND METHODS

This was a retrospective cross-sectional descriptive study. All consecutive patients infected with HIV1 followed at the Dermatology Department of Rabat Military Hospital between January 2008 and January 2017 were studied for dermatological manifestations, CD4 count and CDC clinical stage.

RESULTS

A total of 170 patients with 304 dermatological manifestations were included. The most common dermatoses were fold dermatophytic infections (67%), genital warts (43%), herpes zoster (21%), xerosis (21%), and oral candidiasis (12%). The number of dermatologic manifestations was significantly greater in patients with CD4 count less than 200/mm³ or in stage C of the CDC classification. Five types of skin diseases (dermatophyte infections of the folds, genital warts, shingles, oral candidiasis, and seborrheic dermatitis) were significantly associated (P < 0.05) with CD4 count <200/mm³ . Seborrheic dermatitis was the only one skin disease significantly associated with AIDS stage. In multivariate analysis, genital warts (OR = 0.3, 95% CI 0.10-0.92) are independently associated with CD4 count less than 200 CD4/mm³ .

CONCLUSIONS

Skin manifestations not only act as markers but also reflect the underlying immune status. Seborrheic dermatitis and genital warts appear to be a marker of immune status, and seborrheic dermatitis appears to be associated with CDC stage C, especially in their chronic and severe forms.

[Vitiligo revealing Vogt -Koyanagi-Harada disease]

Le vitiligo est une dermatose chronique auto-immune, souvent associé ou fait découvrir d'autres pathologies auto-immunes. Son association à une atteinte ophtalmologique à type de pan uvéite et /ou une atteinte neurologique à type de méningite et/ou de l'oreille interne à type de surdité détermine la maladie ou le syndrome de Vogt-Koyanagi-Harada (VKH). Nous rapportons le cas d'une jeune femme qui consultait pour des uvéites récidivantes depuis un an, Et ce n'était qu'avec l'apparition des lésions de vitiligo que le diagnostic de maladie de VKH a été évoqué et confirmé.

[Pseudo-condylomatous neurodermatitis of the anal margin]

Cerebral venous thrombosis (CVT) is a rare origin of stroke, the clinical presentation and etiologies vary. The prognosis is shown to be better compared to arterial thrombosis. Magnetic Resonance Imaging (MRI) and MR Venograpgy (MRV) are currently important tools for the diagnostic. We studied 30 cases of CVT diagnosed in the department of neurology of the University Hospital of Fez (Morocco). Patients diagnosed with CVT signs between January 2003 and October 2007 were included in the study. Cerebral CT-scan was performed in 27 cases (90%) while the MRI examination was done in 18 patients (67%); and most patients (90%) received anticoagulant therapy. The mean age of our patients was of 29 years (age range between 18 days and 65 years). A female predominance was observed (70%). The clinical presentation of patients was dominated by: headache in 24 cases (80%), motor and sensory disability in 15 cases (50%), seizures in 10 cases (33%) , consciousness disorder in 10 cases (33%). CVT was associated to post-partum in 10 cases (33%), infectious origin in 8 cases (26%), Behcet disease in 2 cases (7%), pulmonary carcinoma in 1 case, thrombocytemia in 1 case and idiopathic in 7 cases (23%). The evolution was good in 20 cases (67%), minor squelaes were observed in 6 patients (20%), while major squelaes was observed in 2 cases. Two cases of death were registered. The CVT is a pathology of good prognosis once the diagnosis is promptly established and early heparin treatment initiated.

Aspects épidemiocliniques et évolutifs chez 157 cas de leishmaniose cutanée au Maroc

Connue au Maroc depuis la fin du XIX siècle, la leishmaniose cutanée (LC) constitue un problème de santé publique dans notre pays. Le but de notre travail est de décrire le profil épidémioclinique et l’évolution post thérapeutique chez les patients ayant une leishmaniose cutanée dans notre contexte. Nous avons effectué une étude rétrospective, basée sur l'exploitation des dossiers de malades ayant présenté une leishmaniose cutanée confirmée entre janvier 2003 et décembre 2012. Nous avons colligés 157 cas de leishmaniose cutanée. L’âge moyen des patients était de 34.5 ans avec des extrêmes de 6 ans à 63 ans. Le sex-ratio était de 2.34 H/F. La durée d’évolution moyenne des lésions était de 3,6 mois avec des extrêmes de 2 semaines à 10 mois. Les lésions étaient uniques dans 29.5% des cas. Les lésions siégeaient sur membres dans 63%. La forme ulcèro- croûteuse touchait plus de 48%. Le Glucantime était utilisé dans 29.3% des cas, l'azote liquide était utilisé chez 111 autres. L’évolution post-thérapeutique était favorable avec disparition quasi-complète des lésions dans un délai variant de 6 à 10 semaines, au prix de cicatrices inesthétiques chez 14 patients. La leishmaniose cutanée continue à poser un vrai problème de santé publique dans notre pays. L’émergence de formes sévères et résistantes à travers le monde doit inciter à multiplier et renforcer les mesures prophylactiques.