Paget's disease (PD) of the breast is a rare disease of the nipple-areola complex often associated with underlying carcinoma, accounting for less than 4% of all breast carcinomas. We report a case of Paget's disease remarkable for its rarity, the diagnostic delay and the relatively young age of our patient in the Dermatology department of the Donka National Hospital. A 38-year-old woman consulted for itching of the left nipple associated with an oozing erythematous-squamous plaque and tumor-like left axillary lymphadenopathy evolving since4 years. Clinical examination and histopathology confirmed breast Paget's disease. A left mastectomy with lymph node dissection was performed, supplemented by chemotherapy. The evolution was good with absence of recurrence and metastasis after a follow-up of 16 months. Paget's disease corresponds to the invasion of the nipple epidermis by ductal carcinoma in situ (CIS), a rare variant of CIS. Classically, it develops between the ages of 51 and 70, however cases of Paget's disease of the nipple in young women during periods of genital activity have been reported in the literature as illustrated by our observation. The diagnosis of PD is often made late. An easy biopsy should be offered for all unilateral eczematous lesions of the nipple to compensate for this diagnostic delay. Mastectomy or breast-conserving surgery is often recommended. Adjuvant treatments are discussed on a case-by-case basis.
African histoplasmosis is a rare deep mycosis caused by two varieties of Histoplasma capsulatum (capsulatum and duboisii). We report a case of histoplasmosis in an immunocompetent child. 6-year-old female patient, hospitalized for poor general condition, fluctuating inflammatory swelling of the lower limb evolving for 4 months. The clinical examination revealed in an altered and febrile patient, papulo-nodular lesions of variable size, fluctuating in places, disseminated umbilical predominantly on the trunk, the root of the upper and lower limbs. There were also axillary and inguinal lymphadenopathy and osteo-articular involvement. X-ray of the right lower limb revealed osteomyelitis. Histopathology of the biopsied nodule confirmed African histoplasmosis. The rarity of African histoplasmosis in our country corroborates current data from the literature, however this could also be due to an underdiagnosis often influenced by self-medication.
La perforation stercorale du côlon est une affection rare touchant les malades constipés chroniques, âgés et souvent fragiles. Elle peut aussi survenir chez des patients jeunes. Les auteurs rapportent l’observation d’un patient de 42 ans qui a consulté pour des douleurs abdominales généralisées apparues quatre jours plutôt. Ce patient était VIH positif traité par trois antirétroviraux (lamivudine, névirapine, stavudine). L’examen clinique notait un arrêt des matières et des gaz et un syndrome péritonéal. Sur le cliché de l’abdomen sans préparation, on avait un volumineux pneumopéritoine et une image en double jambage caractéristique d’un volvulus du côlon sigmoïde. À la laparotomie, on découvrait une péritonite pyostercorale, une double perforation du côlon transverse et du côlon sigmoïde, un volvulus du côlon sigmoïde et un fécalome qui s’étendait du rectum à l’angle colique droit. Le patient a eu une hémicolectomie gauche avec colostomie de type Hartmann. Il est décédé à j2 postopératoire d’un choc toxi-infectieux. L’association d’un fécalome géant, d’un volvulus sigmoïdien et d’une perforation stercorale bifocale font l’intérêt de ce cas clinique, jamais rapporté dans la littérature à notre connaissance.
Introduction:The aim of this study was therefore to provide a detailed description of the dermatological conditions presented by prisoners and to determine their determining factors in the largest detention center in Guinea.Material and methods: This work took place in the central house of Conakry.It is a penitentiary establishment built at the beginning of the 20th century for a theoretical capacity of three hundred people.Its occupancy rate in 2013 was 377%, reflecting saturation.From April 1 to 17, 2013, we conducted a descriptive and analytical cross-sectional study that included all prisoners with one or more dermatosis and who agreed to participate in the study.For each inmate, the different types of dermatosis were identified.The frequency of the shower, the use of soap for the shower, the change of clothes and the sanitation of the cells were analyzed by the Chi2 of Pearson at the threshold of 5%.The study was authorized by the prison authorities.Results: One thousand one hundred and thirty-one detainees were examined; 320 had dermatosis, a prevalence of 27.3%.They were 292 men and 28 women with an average age of 30 years and extremes of 15 and 70 years.Infectious dermatosis were the most represented, with 247 cases (77.2%) with a predominance of scabies in 146 inmates, and dermatophytis in 58 inmates.Non-infectious dermatosis accounted for 22.8% of dermatosis with a predominance of contact eczema noted in 27 patients.One hundred and eighty-nine (59%) patients showered irregularly, 62% did not use soap for the shower, 51% irregularly changed their clothes after showering, 70 % of the cells were irregularly cleaned.Seventy-five percent of patients had never had a dermatological consultation.We found a statistically significant relationship between the occurrence of infectious dermatosis and hygienic conditions in prison settings including the frequency of the shower, the use of soap and the frequency of changing clothes. Conclusion:The profile of skin disease observed in the Guinean prison environment is no different from that of the majority of resource-limited countries.These are pathology that can be the subject of preventive measures and/or can be aggravated by precarious conditions of hygiene and detention.
Infantile hemangioma (IH) is the most common benign vascular tumor of childhood. Most of IHs regress spontaneously, yet some require a more rapid intervention. Herein, we report the case of a two-month-old female who was brought in for consultation by the mother with a voluminous segmental IH of the face in respiratory distress. The infant was hospitalized, after taking advice from other specialists and performing a pre-treatment check-up, the patient was administered oral propranolol. Respiration returned to normal after several hours. The evolution was marked by the regression of the hemangioma and positive drug tolerance. Our observation shows the value of early diagnosis and the need for the rapid management of severe segmental IH of the face treated with oral propranolol. Apart from the efficacy of propranolol in the treatment of IH, we report the difficulties due to the unavailability of the adapted syrup form for infants in Guinea.
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