Compound heterozygous SLC29A3 mutation causes H syndrome in a Moroccan patient: A case report

H syndrome is an autosomal recessive syndrome, which affects the skin and some vital organs, it is caused by mutations in the SLC29A3 gene, encoding the human equilibrative nucleoside transporter hENT3. This report describes a patient with typical features of H syndrome. Based on the patient's clinical features, SLC29A3 was selected for molecular investigation. Through direct sequencing, a compound heterozygous alteration in the SLC29A3 gene was found. The c.243delA frameshift mutation leading to a premature termination, resulting in a truncated protein, and a splice site mutation c.300+1G>C predicted to cause a splicing error. This contribution extends the clinical variability of compound heterozygous SLC29A3 mutations resulting in an additional multisystemic manifestation of the clinical spectrum of SLC29A3 disorders.

[Actinomycosic mycetoma of the foot in Morocco due to Actinomycetes viscosus]

We present the case of an actinomycotic mycetoma of the foot due to Actinomycetes viscosus. It evolved for nine years on the foot of a 26-year-old patient from a rural environment: Douar Inezgane (city in southern Morocco). Bacteriological study of the skin and grains confirmed the diagnosis. It showed positive bacilli on direct examination and on Gram staining and in positive culture. Histological study showed a polymorphous granulomatous inflammation without signs of malignancy with actinomycotic grains. Then we retained the diagnosis of primary cutaneous actinomycosis without visceral locations. The treatment was based on antibiotics: penicillin G by intravenous infusion for five weeks, relayed orally by amoxicillin associated with trimethoprim-sulfamethoxazole for long periods. After six months of treatment, we observed a favorable outcome with reduction of the swelling, nodules, lymphadenopathy, fistula's number and extension of time of issue of grains. The current follow up is 15 months. The primary cutaneous actinomycosis is still relevant in Morocco.

[Renal ultrasound in fat necrosis]

Subcutaneous fat necrosis is an uncommon disease that may be complicated with potentially fatal hypercalcemia or with nephrocalcinosis. We report on the case of a patient with a history of significant perinatal asphyxia, hospitalized for a urinary tract infection. Lesions of subcutaneous fat necrosis were noted, with asymptomatic hypercalcemia at 3.9mmol/L. A renal ultrasound was performed and showed echogenic medullary pyramids bilaterally, consistent with nephrocalcinosis and left nephrolithiasis. The treatment of hypercalcemia included hyperhydration, a diuretic and corticosteroids. Progression was characterized by the total regression of skin lesions and normalization of serum calcium. Hypercalcemia is a rare complication of subcutaneous fat necrosis. It develops within days to weeks after the appearance of skin lesions. Nephrocalcinosis appears after several weeks or months. Hypercalcemia must be treated in due time to avoid the impact on the kidney.

[Generalized chromomycosis caused by Phialophora verrucosa]

BACKGROUND

Chromomycosis is a chronic fungal skin infection that generally presents in the form of verrucous or vegetative lesions on uncovered areas of skin. We report an unusual case of generalised chromomycosis due to Phialophora verrucosa.

PATIENTS AND METHODS

A 42-year-old town-dwelling housewife was hospitalised for erythematous keratotic nodules on the arm showing sporotrichoid distribution, associated with a crusted ulcerative lesion on the homolateral index finger, as well as subcutaneous papulonodular lesions. In places, the lesions on the patient's back presented an umbilical and molluscoid appearance. The patient had suffered no previous injuries and had not visited any areas in which leishmaniasis is endemic. Her history included insulin-dependent diabetes. Screening for Leishman bodies was negative. Histopathological analysis of the skin biopsy revealed an epithelioid giant-cell granuloma with no caseous necrosis. The mycological study demonstrated the presence of fumagoid bodies and P. verrucosa was isolated. Treatment with terbinafine was initially given, followed by clarithromycin, but in the absence of any improvement, the patient was readmitted to hospital and is currently on itraconazole and amphotericin B.

DISCUSSION

The novel features of our case comprise the clinical aspect of chromomycosis, the extent of the lesions, their unusual site on the back and upper limbs, and the isolation of a rare species, P. verrucosa (only the second observation in Morocco). It also highlights the therapeutic difficulties posed by this type of chromomycosis.

Syringocystadenoma papilliferum: Unusual location

Syringocystadenocarcinoma papilliferum (SCAP) is rare. We describe a 55-year-old man with a partially eroded lesion on the trunk that developed over one year. Histopathological examination revealed syringocystadenoma papilliferum. A wide excision was performed to remove the tumor. The patient has been well without relapse or metastasis for 8 months.

[Suppurations of the perineal and gluteal region: An aetiological study of 60 cases]

BACKGROUND

The gluteal region is a complex area of the body that may be the seat of several diseases with dermatological manifestations. The purpose of this series was to study the aetiological profile of suppurative lesions of the gluteal region in patients in Morocco.

PATIENTS AND METHODS

A retrospective study was carried out on patients presenting suppuration of the gluteal region hospitalised in our department between 1987 and 2008. The epidemiological, clinical and aetiological data for 60 cases were reviewed. Skin biopsies with bacterial, fungal and histological studies, as well as bacterial and fungal cultures of pus and anorectal examination, were performed for all patients.

RESULTS

We examined the files for 44 males and 16 females; mean age was 44 years (range: 13 to 70 years) and the average duration of illness was 6.5 years. The various aetiologies were as follows: hidradenitis suppurativa (27 cases), cutaneous tuberculosis (10 cases), Crohn's disease (nine cases), phlegmon-carbuncle (eight cases), tumours (four cases) and deep mycosis (two cases). Medical and surgical treatments were aetiological.

DISCUSSION

There are various aetiologies of suppurations of the gluteal region. In Morocco, hidradenitis suppurativa, cutaneous tuberculosis and Crohn's disease are the most frequent causes. Multidisciplinary management is essential.

[Fatal progression of Bannayan-Zonana syndrome]

Bannayan-Zonana syndrome is a rare entity characterized by macrocephaly and multiple soft tissue and visceral hamartomas and lipomas. Knowledge of this syndrome is important given the risk of sometimes fatal bleeding and visceral neoplasia in adulthood. We report on a new case, original in its sporadic occurrence and rapidly fatal progression.

Evaluation of the effectiveness of a broad-spectrum sunscreen in the prevention of chloasma in pregnant women

BACKGROUND

Chloasma, or melasma, is a pigmentary disorder that can affect between 50% and 70% of pregnant women. During pregnancy, chloasma does not require any particular treatment beside the use of an effective sunscreen and avoiding the use of any photosensitizing products or inappropriate skin care routine. However, there exist very few studies related to the benefits of sunscreens to prevent this dermatosis.

OBJECTIVE

The aim of this study was to assess the role of a broad-spectrum sunscreen in the prevention and treatment of chloasma in pregnant women.

METHODS

We tested the effectiveness and tolerance of a sunscreen composition (SPF 50+, UVA-PF 28) during a 12-month clinical trial on 200 parturients.

RESULTS

The 'excellent' tolerance of the sunscreen under evaluation was confirmed. Out of 185 patients who completed the study, only five new cases of chloasma were noted, an occurrence of 2.7%, which is much lower than the 53% previously observed in an usual condition study (same investigators, same geographical area and same time frame). In addition, the clinical effectiveness of the evaluated sunscreen was judged 'excellent' by the majority of parturients and by the research dermatologists during all the consultations. It is also worth noting that at 6 months, a clinical improvement was observed in 8 out of 12 volunteers who were affected by a pre-existing chloasma observed during their inclusion visit. Colorimetric measurements showed that, at the end of their pregnancy, the parturients' skin was, on average, significantly lightened (increase of parameter L* in 38% cases) and less pigmented (reduction of parameter b* in 50% cases); thus, resulting in a significantly lighter skin colour (increase of ITA degrees in 69% cases) compared to their inclusion visit.

CONCLUSIONS

This study clearly demonstrates the effectiveness of the well-tolerated broad-spectrum sunscreen evaluated, in the prevention of the development of chloasma in pregnant women.

Syndrome de Fahr secondaire à une hypoparathyroïdie à révélation dermatologique

BACKGROUND

Fahr syndrome is defined by the presence at the brain base of strio-pallido-notched non-arteriosclerotic bilateral and symmetric calcifications. We report an observation of Fahr syndrome revealed by a growing pyodermitis in direct relation with hypocalcemia.

OBSERVATION

A 17 year-old girl was admitted to the Dermatology Department for a growing pyodermitis of the large folds. The patient was known to be epileptic and had undergone surgery for a left eye cataract a year before. Microbiologic and mycologic examinations of the pus and of the cutaneous fragments were negative. During hospitalization, the patient had an attack of tetany, a laryngeal spasm and a generalized erythema thrust studded with pustules. The phosphocalcic assessment showed severe hypocalcemia and hyperphosphoremia. Parathormone serum rate was decreased. The brain tomodensitometry conveyed bilateral calcifications of the central gray nucleus. The diagnosis of a growing amicrobial pustulosis secondary to an idiopathic hypoparathyroidism and responsible for the Fahr syndrome was maintained. Treatment was composed of calcium (2 g/day) and vitamin D3. The evolution was favorable with a relapse at 2 years.

DISCUSSION

We report an idiopathic hypoparathyroidism associated with Fahr syndrome conveyed by growing amicrobial pustulosis. We discuss the dermatologic manifestations of Fahr syndrome associated with hypoparathyroidism and the physiopathologic mechanisms of the dermatologic lesions during hypocalcemia.

[Juvenile hyaline fibromatosis: 2 twin brothers affected]

INTRODUCTION

Juvenile hyaline fibromatosis is a rare hereditary genetic disease characterized by a cutaneous tumoral fibroblastic proliferation with joint involvement.

CASE-REPORT

We report the case of 2 homozygous twin brothers both presenting a diffuse and invalidating form of juvenile hyaline fibromatosis. The 2 boys' born of a twin pregnancy' presented at the age of 2 months a clinical picture made up by the classic association: infiltrated papulo-nodules, gingival hyperplasia and joint contracture. The diagnosis of juvenile hyaline fibromatosis suggested clinically was confirmed by the histological study of the skin.

DISCUSSION

These observations of juvenile hyaline fibromatosis's are particular in the involvement of 2 twin brothers, which to our knowledge has never been reported, the resemblance of the clinical features, and the severity of the functional handicap.

[Loose anagen hair syndrome: a familial case with fetal hair in meconium]

INTRODUCTION

Loose anagen hair syndrome is a recently described hair disorder. We report a familial case.

CASE REPORT

Two sisters were examined, 4 years-old and 8 months old, from a consanguineous marriage. At birth, they presented diffuse alopecia of the scalp; the meconium contained black and silky hair. Clinical examination noted the short, fine hair with easy and painless uprooting. No clinical associated symptoms were observed. The trichogram showed 70 p. 100 of anagen hair and 30 p. 100 of telogen hairs.

DISCUSSION

Our familial case is original by this clinical symptom: discharge of probably dystrophic foetal hair in the meconium. Loose anagen hair is characterised by easily pluckable hair. The trichogram confirms the diagnostic. It is composed of anagen hairs (80 to 100 p. 100) devoid of sheaths. The loose anagen hair is usually isolated, but associations have been reported. It may occur in families. The precise pathogenesis and treatment of this hair disorder are not known.

[Icthyosiform erythroderma: atypical manifestation of sarcoidosis]

BACKGROUND

Specific cutaneous manifestations of sarcoidosis can be extremely varied. We report one observation of cutaneous sarcoidosis with an exceptional clinical presentation: icthyosiform erythroderma.

CASE REPORT

A 33-year-old woman had a dry icthyosiform erythroderma associated with arthralgia and muscular deficit of the pelvic belt in a context of fever and weight loss. Skin biopsy revealed the presence of an epithelioid giant-cell granuloma. This granuloma was also found in the salivary glands and in the bronchial mucosa. The chest X ray showed diffuse reticularis opacities. The diagnosis of sarcoidosis was retained. The patient was treated with oral prednisone (0.75 mg/kg/day). Total skin clearing was obtained after 15 days.

DISCUSSION

This observation points out the heterogeneous nature of clinical manifestations of cutaneous sarcoidosis. The icthyosis erythroderma form is exceptional. Correct diagnosis is difficult and must be based on clinical, histological, radiological and biological criteria of sarcoidosis.