A destructive centrofacial granuloma: Case report

Introduction

Centrofacial granulomas have several etiologies, which poses diagnostic difficulties and delays in management. Herein, we report a confusing case revealing granulomatosis with polyangiitis (GPA) in its localized form.

Case presentation

A 76-year-old man presented with a pruritic centrofacial placard that had been evolving for 3 years. On examination, there was a centrofacial infiltrated and erythematous papulonodular placard. Skin biopsies were not conclusive. The immunological assessment was negative. The evolution was marked by the extension of the placard, the destruction of the nasal pyramid and nasal mutilation. Only surgical biopsy revealed dermohypodermal, cartilaginous and endonasal non-necrotizing granulomatous tuberculoid inflammation with leukocytoclastic and necrotizing vascularitis. The diagnosis of GPA in its localized form was retained. Treatment with prednisone was initiated combined with monthly boluses of cyclophosphamide. The assessment for systemic involvement remained negative during the follow-up.

Clinical discussion

Localized forms represent up to 29% of GPA cases. There are clinical, but also biological differences, since ANCA are found in more than 90% of diffuse forms and only in 50–78% of localized forms. Our case may represent a rare distinctive subset of GPA limited to the facial region and upper airway mucosa but showing a locally aggressive behaviour leading to cartilage and bony destruction.

Conclusion

It is necessary to evoke GPA in its localized form and to perform multiple deep biopsies in front of any facial granulomatosis. Early diagnosis and appropriate treatment prevent mutilating and disfiguring sequelae.

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GPA is not always associated with the presence of ANCA.

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A distinction can be made between diffuse and localized forms.

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Limited disease has increased risk of disease exacerbation following remission.

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We report a case of GPA showing local aggressive behaviour.

[Cutaneous leishmaniasis of the vermilion border of the upper lip extending to the oral mucosa]

BACKGROUND

Cutaneous leishmaniasis is endemic in Morocco. Mucosal involvement is rare. We report a case in Morocco of cutaneous leishmaniasis of the vermilion border of the upper lip extending to the oral mucosa due to Leishmania tropica.

PATIENTS AND METHODS

A 15-year-old girl was seen with 2 ulcerated lesions, present for 4 months, situated on the left cheek and vermilion border and extending to the oral mucosa. The diagnosis of leishmaniasis was confirmed by direct examination revealing high numbers of Leishmania amastigotes. Culture of the offending organism in NNN medium and isoenzymatic characterization resulted in identification of L. tropica. Treatment with meglumine antimoniate (Glucantime) was ineffective. The outcome was good after treatment with fluconazole.

CONCLUSION

In Morocco, cutaneous leishmaniasis with mucosal involvement is rare, and usually develops as a complication of cutaneous leishmaniasis via direct extension.

Giant perianal condyloma acuminatum in an infant without sexual abuse

Giant condyloma acuminatum is rare in infants. We report a case of giant perianal condyloma in a 10-month-old infant without sexual abuse. The patient was treated by surgical excision associated with electrocoagulation with no recurrence after 2 years. While both sexual and nonsexual transmissions are possible in patients with condyloma acuminatum, sexual abuse must always be considered in children.

Hypotrichosis with juvenile macular dystrophy: Portuguese case

Hypotrichosis with juvenile macular dystrophy is a rare congenital disease mainly found in the Druze population of Northern Israel. This disorder is caused by the CDH3 mutation encoding P-cadherin, which is expressed in retinal pigment epithelium and hair follicles. An 11-year-old girl who was born to related Portuguese parents, had hypotrichosis since birth and macular dystrophy diagnosed at age 5. Fundus examination and fluorescein angiography revealed located macular pigmentary abnormalities. No molecular analysis was done. A fundus examination should be considered mandatory in the assessment of congenital hypotrichosis.

Psoriasis and Staphylococcus aureus skin colonization in Moroccan patients

Psoriatic lesions are rarely complicated by recurrent infections. The aim of our study is to determine skin colonisation and nasal carriage of Staphylococcus aureus in patients with psoriasis and in healthy persons. Patients and methods: a comparative study that include 33 patients with psoriasis and 33 healthy persons. Samples were taken from lesional and non lesional psoriatic skin and from healthy skin of control group. For S. aureus nasal carriage, we used sterile cotton tipped swabs. Out of165 samples (66 skin samples and 33 nasal swabs), 26 S. Aureus strains were isolated in 26 persons, 57.69% in the control group and 42.3% in the psoriasisgroup. S. aureus skin colonization was found in one case (3%) inlesional psoriatic skin vs 9 cases (27.3%) in control skin OR=0.08 IC 95% (0.01-0.70) p=0.02 and in 12,1% in non lesional soriatic skin vs 27, 3% in control skin (p =0,13). This colonization was less important in lesional psoriatic skin (3%) than in non lesional psoriatic skin (12.1%) p= 0.20. Nasal screening identified (7/33) 21, 21% S. aureus carriers in psoriasis group and in control group. Our results are in consensus withliterature findings. They have confirmed the importance of antimicrobial peptides in Innateimmunity of human skin. These peptides are normally produced bykeratinocytes in response to inflammatory stimuli such as psoriasis. Their high expression in psoriasis skin reduces the risk of skin infection and skin colonization with S. Aureus.

Cutaneous sarcoidosis simulating porokeratosis of Mibelli

We report a skin localization of systemic sarcoidosis, which presented with lesions that resemble porokeratosis of Mibelli. Skin biopsy showed non-caseating sarcoidal granuloma. Whereas cutaneous sarcoidosis is present in up to one-third of cases and may present with a wide variety of lesions, our presentation is uncommon. Partial remission was obtained with hydroxychloroquine and prednisone

[Nodular cutaneous amyloidosis associated with Sjögren's syndrome]

BACKGROUND

Cutaneous nodular amyloidosis is rare, and association with Sjögren's syndrome has been reported. We discuss the possible link between these two diseases based on a case we saw.

PATIENTS AND METHODS

A 78-year-old woman with Sjögren's syndrome ongoing for 17 years presented for evaluation of a waxy infiltrated lesion on her left leg that had appeared 6 months earlier. Histopathological examination revealed a deposit of homogenous eosinophilic material throughout the dermis consistent with amyloidosis. Immunohistochemical study showed these deposits to be AL immunoglobin light chains.

DISCUSSION

The association of cutaneous nodular amyloidosis and Sjögren's syndrome appears to be a distinct disease entity reflecting the polymorphic clinical spectrum of lymphoproliferative diseases related to Sjögren's syndrome.