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The aim of the study was to assess the impact of aging on neuromuscular fatigue and recovery. Ten young (23.08 ± 1.43 years) and older (61.19 ± 1.80 years) males performed an intermittent maximal isometric exercise with the knee extensors followed by 27 min of recovery. Maximal voluntary contraction (MVC), total work (W'), voluntary activation (VA), potentiated resting twitch (Ptw), and electromyography (EMG) were recorded and then analyzed. Peripheral and central fatigue following exercise were lower in old compared to young (- 29.99% vs. - 42.68% and - 14.55 vs. - 20.02%; P < 0.05, respectively). Despite old performing 50% less work, RMS/Mmax reduction was similar between old and young (- 26.46% vs. - 29.93%; P > 0.05, respectively). During the recovery period, our results showed that recovery of the MVC was impaired for old (14.93% for old vs. 30.66% for young) and still incomplete until 27 min.VA increased significantly compared to post exercise after 1 min only for young (P = 0.001), potentially affecting the recovery pattern of MVC during the early phase due to their significant correlation (r2 = 0.58, P = 0.01). Peripheral fatigue recovery was also lower for old (11.18% vs. 18.72%; P < 0.001), and both groups failed to recover their baseline value (both P < 0.005). The lower peripheral and central fatigue observed in elderly following exercise appears for the first instance as a fatigue resistance. However, the delayed neuromuscular recovery reveals instead a reduced fatigue tolerance reflecting age-related alteration within contractile properties and/or within central nervous system.
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PURPOSE: The aims of this study were to compare cerebral hemodynamics and maximal oxygen uptake (VO2peak) in patients with end-stage renal disease (ESRD) vs. age-matched healthy controls during maximal exercise. METHODS: Twelve patients with ESRD and twelve healthy adults (CTR group) performed exhaustive incremental exercise test. Throughout the exercise test, near-infrared spectroscopy allowed the investigation of changes in oxyhemoglobin (∆O2Hb), deoxyhemoglobin (∆HHb), and total hemoglobin (∆THb) in the prefrontal cortex. RESULTS: Compared to CTR, VO2peak was significantly lower in ESRD group (P < 0.05). Increase in ∆THb (i.e., cerebral blood volume) was significantly blunted in ESRD (P < 0.05). ESRD patients also had impaired changes in cerebral ∆HHb and ∆O2Hb during high intensity of exercise (P < 0.05). Finally, no significant correlation was observed between VO2peak and changes in cerebral hemodynamics parameters in both groups (All P > 0.05). CONCLUSION: Maximal exercise highlights subtle disorders of both hemodynamics and neuronal oxygenation in the prefrontal cortex in patients with ESRD. This may contribute to both impaired cognitive function and reduced exercise tolerance throughout the progression of the disease.
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Circulación Cerebrovascular , Ejercicio Físico , Fallo Renal Crónico , Consumo de Oxígeno , Humanos , Masculino , Fallo Renal Crónico/fisiopatología , Fallo Renal Crónico/terapia , Fallo Renal Crónico/complicaciones , Femenino , Persona de Mediana Edad , Adulto , Ejercicio Físico/fisiología , Circulación Cerebrovascular/fisiología , Consumo de Oxígeno/fisiología , Hemodinámica , Prueba de Esfuerzo , Espectroscopía Infrarroja Corta , Corteza Prefrontal/fisiopatología , Corteza Prefrontal/metabolismoRESUMEN
PURPOSE: The present study aimed to characterize the exercise-induced neuromuscular fatigue and its possible links with cerebral and muscular oxygen supply and utilization to provide mechanistic insights into the reduced exercise capacity characterizing patients with end-stage renal disease (ESRD). METHODS: Thirteen patients with ESRD and thirteen healthy males (CTR group) performed a constant-force sustained isometric contraction at 50% of their maximal voluntary isometric contraction (MVC) until exhaustion. Quadriceps muscle activation during exercise was estimated from vastus lateralis, vastus medialis, and rectus femoris EMG. Central and peripheral fatigue were quantified via changes in pre- to postexercise quadriceps voluntary activation (ΔVA) and quadriceps twitch force (ΔQtw,pot) evoked by supramaximal electrical stimulation, respectively. To assess cerebral and muscular oxygenation, throughout exercise, near-infrared spectroscopy allowed investigation of changes in oxyhemoglobin (∆O2Hb), deoxyhemoglobin (∆HHb), and total hemoglobin (∆THb) in the prefrontal cortex and in the vastus lateralis muscle. RESULTS: ESRD patients demonstrated lower exercise time to exhaustion than that of CTR (88.8 ± 15.3 s and 119.9 ± 14.6 s, respectively, P < 0.01). Following the exercise, MVC, Qtw,pot, and VA reduction were similar between the groups (P > 0.05). There was no significant difference in muscle oxygenation (∆O2Hb) between the two groups (P > 0.05). Cerebral and muscular blood volume (∆THb) and oxygen extraction (∆HHb) were significantly blunted in the ESRD group (P < 0.05). A significant positive correlation was observed between time to exhaustion and cerebral blood volume (∆THb) in both groups (r2 = 0.64, P < 0.01). CONCLUSIONS: These findings support cerebral hypoperfusion as a factor contributing to the reduction in exercise capacity characterizing ESRD patients.
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Contracción Isométrica , Fallo Renal Crónico , Fatiga Muscular , Humanos , Masculino , Fallo Renal Crónico/fisiopatología , Fallo Renal Crónico/terapia , Fatiga Muscular/fisiología , Adulto , Contracción Isométrica/fisiología , Persona de Mediana Edad , Tolerancia al Ejercicio/fisiología , Músculo Cuádriceps/fisiopatología , Músculo Cuádriceps/irrigación sanguínea , Músculo Cuádriceps/metabolismo , Hemodinámica/fisiología , Consumo de Oxígeno/fisiología , Ejercicio Físico/fisiología , Músculo Esquelético/fisiopatologíaRESUMEN
PURPOSE: This study aimed to examine if peripheral fatigue is adjusted during knee extensor (KE) exercise in order not to surpass a critical threshold patient with type 1 diabetes (T1D) and the consequences of this mechanism on the force-duration relationship. METHODS: Eleven T1D individuals randomly performed two different sessions in which they performed 60 maximum voluntary contractions (MVC; 3 s contraction, 2 s relaxation). One trial was performed in the non-fatigued state (CTRL) and another after fatiguing neuromuscular stimulation of the KE (FNMES). Peripheral and central fatigue were quantified by the difference between pre and post exercise in quadriceps voluntary activation (ΔVA) and potentiated twitch (ΔPtw). Critical torque (CT) was determined as the average force of the last 12 contractions, whereas W' was calculated as the area above the CT. RESULTS: Although FNMES led to a significant decrease in potentiated twitch (Ptw) before performing the 60-MVCs protocol (p < 0.05), ΔVA (â¼ -7.5%), ΔPtw (â¼ -39%), and CT (â¼816 N) post-MVCs were similar between the two conditions. The difference in W' between CTRL and FNMES was correlated with the level of pre-fatigue induced in FNMES (r2 = 0.60). In addition, W' was correlated with ΔPtw (r2 = 0.62) in the CTRL session. CONCLUSION: Correlative results in the present study indicate that regulating peripheral fatigue mechanisms at a critical threshold limit W'. Additionally, peripheral fatigue during KE exercise is limited to an individual threshold in T1D patients.
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Diabetes Mellitus Tipo 1 , Fatiga Muscular , Humanos , Fatiga Muscular/fisiología , Diabetes Mellitus Tipo 1/complicaciones , Músculo Cuádriceps/fisiología , Terapia por Ejercicio , Torque , Músculo Esquelético/fisiología , Electromiografía , Contracción Isométrica/fisiología , Contracción MuscularRESUMEN
Langerhans cell histiocytosis is part of a larger group of syndromes described as histiocytoses. The disease may involve single or multiple systems including skin and nervous system. Here we report an adult case where Langerhans cell histiocytosis presented with diabetes insipidus and cutaneous ulcers.
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Diabetes Insípida/etiología , Histiocitosis de Células de Langerhans/complicaciones , Úlcera Cutánea/etiología , Biopsia , Diabetes Insípida/diagnóstico , Diabetes Insípida/terapia , Femenino , Histiocitosis de Células de Langerhans/diagnóstico , Histiocitosis de Células de Langerhans/terapia , Humanos , Valor Predictivo de las Pruebas , Úlcera Cutánea/diagnóstico , Úlcera Cutánea/terapia , Adulto JovenAsunto(s)
Erupciones por Medicamentos/etiología , Eosinofilia/inducido químicamente , Adolescente , Adulto , Alopurinol/efectos adversos , Antiinfecciosos/efectos adversos , Antiinflamatorios no Esteroideos/efectos adversos , Anticonvulsivantes/efectos adversos , Carbamazepina/efectos adversos , Niño , Combinación de Medicamentos , Exantema/inducido químicamente , Femenino , Glucosamina/efectos adversos , Glucosamina/análogos & derivados , Supresores de la Gota/efectos adversos , Humanos , Masculino , Persona de Mediana Edad , Prurito/inducido químicamente , Estudios Retrospectivos , Sulfasalazina/efectos adversos , Síndrome , Combinación Trimetoprim y Sulfametoxazol/efectos adversos , Adulto JovenRESUMEN
Invasive aspergillosis is a life-threatening condition in patients with chronic granulomatous disease (CGD). Skin invasion by Aspergillus occurs most commonly by contiguity to a neighboring cavity. We describe an unusual case of invasive cutaneous aspergillosis presented as a large burgeoning tumor in a 4-year-old girl with CGD who underwent surgical treatment for bifocal osteomyelitis of the left leg. The skin invasion occurred 4 months after a "successful" treatment of invasive pulmonary aspergillosis. Atypical presentation and diagnostic difficulties are discussed. Invasive cutaneous aspergillosis may be polymorphic. The diagnosis should be considered early in the etiological investigation of any suspicious skin lesions in CGD even in uncommon aspects such as burgeoning tumors.
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Dermatomicosis/microbiología , Drenaje/efectos adversos , Enfermedad Granulomatosa Crónica/complicaciones , Aspergilosis Pulmonar Invasiva/microbiología , Osteomielitis/cirugía , Piel/microbiología , Infección de la Herida Quirúrgica/microbiología , Antifúngicos/uso terapéutico , Biopsia , Preescolar , Desbridamiento , Dermatomicosis/diagnóstico , Dermatomicosis/terapia , Femenino , Enfermedad Granulomatosa Crónica/diagnóstico , Humanos , Aspergilosis Pulmonar Invasiva/complicaciones , Aspergilosis Pulmonar Invasiva/diagnóstico , Aspergilosis Pulmonar Invasiva/tratamiento farmacológico , Osteomielitis/diagnóstico , Osteomielitis/microbiología , Piel/patología , Infección de la Herida Quirúrgica/diagnóstico , Infección de la Herida Quirúrgica/terapia , Resultado del TratamientoRESUMEN
BACKGROUND: Major histocompatibility complex class II deficiency, also referred to as bare lymphocyte syndrome is a rare primary Immunodeficiency disorder characterized by a profondly deficient human leukocyte antigen class II expression and a lack of cellular and humoral immune responses to foreign antigens. Clinical manifestations include extreme susceptibility to viral, bacterial, and fungal infections. The infections begin in the first year of life and involve usually the respiratory system and the gastrointestinal tract. Severe malabsorption with failure to thrive ensues, often leading to death in early childhood. Bone marrow transplantation is the curative treatment. CASE REPORTS: Here we report two cases with a late outcome MHC class II deficiency. They had a long term history of recurrent bronchopulmonary and gastrointestinal infections. Bone marrow transplantation could not be performed because no compatible donor had been identified. At the age of 12 years, they developed oral papillomatous lesions related to HPV (human papillomavirus). The diagnosis of HPV infection was done by histological examination. HPV typing performed on the tissue obtained at biopsy showed HPV type 6. The lesions were partially removed after two months of laser treatment. CONCLUSIONS: Viral infections are common in patients with MHC class II and remain the main cause of death. Besides warts caused by HPV infection do not exhibit a propensity for malignant transformation; they can cause great psychosocial morbidity.
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BACKGROUND: Cutaneous adverse drug reactions (CADR) are frequent in children. They have different clinical presentations and may be caused by several drugs. AIM: To evaluate the epidemioclinical features of cutaneous adverse drug reactions (CADR) and the different causative drugs in a Tunisian paediatric series. METHODS: We have retrospectively included 90 children (under 16 years old) with a well documented cutaneous drug reaction, seen in the Department of Dermatology of Charles Nicolle hospital of Tunis over 18 years (1991-2008). Age, gender, duration of skin disorders, type of cutaneous lesions, incriminated drugs, delay between drug consumption and eruption, validation by the national pharmacovigilance centre, treatment and outcome were recorded. RESULTS: Our patients were 6.9 year-aged (sex-ratio M/F 1.19). They had maculopapular eruption (MPE) (57.7%), acute urticaria (16.6%), fixed drug eruption (14.4%), erythema multiform (2.2%), photosensitization (1.1%) or severe cutaneous drug reactions (10%).Incriminated drugs were: Antibiotics (55.5%), non-steroidal antiinflammatory drugs (18.8%), antiepileptics (11.1%), and analgesics (5.5%). Betalactamins were the most commonly incriminated antibiotics (32 out of 50 patients; 64%). Barbiturates were the most commonly incriminated anti-epileptics (7/90 cases, 7.7%). Favourable outcome was noted in all patients, even those with severe drug reactions. CONCLUSION: MPE to antibiotics were the most common kinds of CADR in children. Drug responsibility should be based on solid criteria given the frequency of MPE of infectious origin and the frequent prescription of antibiotics in paediatric population.
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Erupciones por Medicamentos/epidemiología , Erupciones por Medicamentos/patología , Adolescente , Analgésicos/efectos adversos , Antibacterianos/efectos adversos , Antiinflamatorios no Esteroideos/efectos adversos , Anticonvulsivantes/efectos adversos , Niño , Preescolar , Femenino , Humanos , Lactante , Masculino , Estudios Retrospectivos , Túnez/epidemiologíaRESUMEN
Pigmented Bowen disease (PBD) is a rare tumor characterized by increased melanin pigment in the epidermis or papillary dermis in addition to the typical findings of Bowen disease. We report the case of a 60-year-old woman who presented with a 6-month history of a gradually enlarging solitary dark brown plaque in her right inguinal region. Histopathology showed hyperkeratosis with parakeratosis, acanthosis, disorganization of epidermal architecture, atypical keratinocytes, and increased melanin pigment of the papillary dermis. Considering the clinical and the histological evidence, a diagnosis of PBD was established. Complete resection confirmed the diagnosis. Pigmented Bowen disease is an unusual form of squamous carcinoma in situ. Other tumors in the differential diagnosis include pigmented basal cell carcinoma and superficial spreading melanoma.
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Enfermedad de Bowen/diagnóstico , Melaninas/análisis , Neoplasias Cutáneas/diagnóstico , Enfermedad de Bowen/química , Enfermedad de Bowen/patología , Carcinoma Basocelular/diagnóstico , Dermis/química , Dermis/ultraestructura , Diagnóstico Diferencial , Femenino , Ingle , Humanos , Queratosis Seborreica/diagnóstico , Melanoma/diagnóstico , Persona de Mediana Edad , Neoplasias Cutáneas/química , Neoplasias Cutáneas/patologíaRESUMEN
PURPOSE: To remind special attention to atypical symptoms of Hansen's disease, we report a case of an atypical case due to a delayed diagnosis. BACKGROUND: Clinical features of leprosy are well known, cutaneous lesions and involvement of the peripheral nerves being the cardinal clinical signs. Among these presentations, systemic involvement, including mucous membranes of the upper respiratory tract and eyes, is rarely reported even if it is still commonly seen in endemic areas, in particular lepromatous leprosy. CASE REPORT: We describe here a new case of Hansen's disease in a 51-year-old Tunisian woman with an atypical presentation and a delayed diagnosis. The early symptoms of the disease were different from the main clinical signs of Hansen's disease since they involved the upper respiratory tract and the eyes. A nasal smear was positive for acid-fast bacilli, thus confirming the diagnosis of bacilliferous leprosy. Histological findings suggested the diagnosis of leprosy and were somewhat more characteristic of the borderline lepromatous type. CONCLUSION: Diagnosis of Hansen's disease in patients with neither apparent skin lesions nor neurological signs is still problematic. Clinicians should not only pay attention to the more obvious signs in their own fields of expertise but should be aware of the possible systemic involvement of leprosy.
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Lepra Lepromatosa/diagnóstico , Mycobacterium leprae , Nariz/microbiología , Alopecia/etiología , Diagnóstico Tardío , Ectropión/etiología , Femenino , Ronquera/etiología , Humanos , Lepra Lepromatosa/complicaciones , Lepra Lepromatosa/patología , Persona de Mediana Edad , Obstrucción Nasal/etiologíaRESUMEN
OBJECTIVE: We present a case of acrodermatitis enteropathica in a full-term, breast-fed, 7-mo-old infant born from consanguineous parents with a family history of acrodermatitis enteropathica. METHODS: The patient presented with periorificial and symmetric acral lesions, which prompted us to review the clinical features of acrodermatitis enteropathica and its pathogenesis. Laboratory investigations showed low zinc levels in the infant's and mother's sera and in the mothers' milk. RESULTS: A diagnosis of acrodermatitis enteropathica was made. A mutation screening of the SLC39A4 gene in the patient and his mother showed heterozygosity for the deletion c.1223_1227delCCGGG. The diagnosis of transient symptomatic zinc deficiency was then established. CONCLUSION: Transient symptomatic zinc deficiency is generally reported in premature infants but should also be considered in full-term, breast-fed infants, as in the present case.
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Acrodermatitis/diagnóstico , Leche Humana/química , Mutación , Zinc/deficiencia , Acrodermatitis/genética , Lactancia Materna , Enfermedades Carenciales/diagnóstico , Diagnóstico Diferencial , Humanos , LactanteRESUMEN
Erythema elevatum diutinum (EED) is a rare condition with an unclear pathogenesis. Initially classified within neutrophilic dermatoses, it is now considered as a leukocytoclastic vasculitis accordingly to its histopathologic pattern. Several clinical presentations as well as many associated diseases are reported in the literature. We report a new case of EED in a 58-year-old man who presented with a three-month history of plaques and nodules on the extensor surfaces of hands, elbows, knees, ankles, forearms, and buttocks. Histology showed a leucocytoclastic vasculitis, suggestive of the diagnosis of EED. Screening for an associated pathology, namely a paraproteinemia or a solid cancer, was negative. Treatment with dapsone leads to amelioration within few weeks.
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Antiinflamatorios/uso terapéutico , Dapsona/uso terapéutico , Vasculitis Leucocitoclástica Cutánea/tratamiento farmacológico , Vasculitis Leucocitoclástica Cutánea/patología , Humanos , Masculino , Persona de Mediana EdadRESUMEN
INTRODUCTION: Kindler's syndrome is a rare type of genetic skin condition belonging to the class of bullous poikilodermia. We report three new sibling cases of this rare syndrome. CASES REPORTS: The condition was seen in three sisters aged 12, 16 and 20 years, born of a first-degree consanguineous marriage with no family history of Kindler's syndrome. The three patients presented spontaneously regressive bullous eruptions, poikilodermia of gradual onset, major cutaneous atrophy on the back of the hands and the feet, photosensitivity and gingival hypertrophy. Electron microscopy examination of poikilodermic skin showed normal anchoring filaments and intraepidermal cleavage. DISCUSSION: Diagnosis of Kindler's syndrome is based upon clinical evidence. Kidler's syndrome is a well defined clinical entity. Ultra-structural studies show intraepidermal, junctional, and dermal cleavage. This syndrome must be differentiated from congenital epidermolysis bullosa, Weary's syndrome, and other bullous hereditary poikilodermas.
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Vesícula/patología , Epidermólisis Ampollosa/patología , Enfermedades Periodontales/patología , Trastornos por Fotosensibilidad/patología , Adolescente , Vesícula/diagnóstico , Vesícula/epidemiología , Vesícula/genética , Niño , Consanguinidad , Dermis/ultraestructura , Diagnóstico Diferencial , Epidermis/ultraestructura , Epidermólisis Ampollosa/diagnóstico , Epidermólisis Ampollosa/epidemiología , Epidermólisis Ampollosa/genética , Femenino , Genes Recesivos , Humanos , Microscopía Electrónica , Enfermedades Periodontales/diagnóstico , Enfermedades Periodontales/epidemiología , Enfermedades Periodontales/genética , Trastornos por Fotosensibilidad/diagnóstico , Trastornos por Fotosensibilidad/epidemiología , Trastornos por Fotosensibilidad/genética , Túnez/epidemiología , Adulto JovenRESUMEN
INTRODUCTION: Acrodermatitis enteropathica is a rare autosomal recessive disease due to an abnormality in a zinc transporting molecule. METHODS: We conducted a retrospective monocentric study on 29 Tunisian cases of Acrodermatitis enteropathica (AE) treated in our Department of Dermatology in Tunisia, between January 1981 and June 2008. RESULTS: The age of onset of disorders was between 15 d and 12 months (mean 6.86 ± 3.25 months). The delay of consultation ranged between 15 d and 8 months (mean of 2.8 ± 2.17 months) after onset. Onset of gastrointestinal and psychiatric signs depended significantly on consulting times. Plasma zinc levels ranged between 14 and 88 lg/100 ml (mean 44.86 ± 18.4 lg/100 ml). There was not a significant relation between zincemia and clinical features. Genetic analyses in 13 of our patients showed three different mutations in the SLC39A4 gene: c.1223_1227del (p.Trp411ArgfsX7) in exon 7,c.143T>G (p.Leu48X) in exon 1 and c.1784T>C (p.Gly595Val) in exon 11. No significant genotype-phenotype correlations could be established. CONCLUSION: Acrodermatitis enteropathica is a rare disease which diagnosis is easy. Its biological confirmation is made on a simple dosage of zincemia. However, the diagnosis is not always suggested, and is unfortunately made late. At present, there is a molecular test to detect SLC39A4 mutations.
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Proteínas de Transporte de Catión/genética , Suplementos Dietéticos , Zinc/sangre , Acrodermatitis/diagnóstico , Acrodermatitis/tratamiento farmacológico , Acrodermatitis/genética , Encefalopatías Metabólicas/tratamiento farmacológico , Encefalopatías Metabólicas/genética , Exones , Femenino , Enfermedades Genéticas Congénitas/metabolismo , Humanos , Lactante , Recién Nacido , Síndromes de Malabsorción/genética , Síndromes de Malabsorción/metabolismo , Masculino , Mutación , Estudios Retrospectivos , Túnez , Zinc/deficiencia , Zinc/uso terapéuticoRESUMEN
BACKGROUND: Pityriasis versicolor is caused by Malassezia sp. It is a common worldwide mycosis. Recently, eleven species are known of the Malassezia genus, and are identified in vitro by their morphological characteristics, biochemical tests and by molecular biology. The aim of this study is the identification of Malassezia species from Tunisian patients with pityriasis versicolor. METHODS: Specimens were taken from 58 patients with pityriasis versicolor. All samples were both inoculated in Sabouraud dextrose agar and Sabouraud agar overlaid with olive oil. Malassezia species were identified by morphological and physiological methods: macroscopy, microscopy, catalase, urease and lipid assimilation tests. RESULTS: We have isolated five Malassezia species: Malassezia globosa being isolated in 76.2% of patients, followed by Malassezia furfur (9.55%), Malassezia sympodialis (4.75%), Malassezia slooffiae (4.75%) and Malassezia pachydermaties (4.75%). CONCLUSION: In our study Malassezia globosa presents the main species implicated in the pathogenicity of pityriasis versicolor and Malassezia furfur as the second agent of importance.
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Malassezia/aislamiento & purificación , Tiña Versicolor/microbiología , Estudios Transversales , HumanosRESUMEN
Peeling skin syndrome (PSS) is a rare form of ichthyosis with a probable autosomal recessive inheritance that exhibits superficial, painless, continual, or seasonal cutaneous exfoliation. The syndrome generally appears at birth or in infancy. We report a case of generalized PSS and provide a literature review. A 34-year-old woman reported a lifelong history of generalized and painless peeling of the skin that worsened in summer. Her parents were third degree cousins. Her twin sister and her two cousins presented with the same condition. Physical examination showed widespread superficial sheets of variable size that could be easily removed without bleeding or pain. No underlying erythema was noted. Otherwise, the patient was in good health. Histological findings showed an epidermal cleavage within the stratum corneum. The generalized form of PSS is classified into 3 types, A, B, and C, according to the classification system of Traupe and Mevorah. We have tried to classify the cases of generalized PSS already reported in the literature into one of these three types. Thirteen reported cases probably presented PSS-type A. Sixteen patients are best described as PSS-type B. Two patients exhibit PSS-type C. Fifteen reported patients had an acral form of peeling skin syndrome. The classification of the eleven remaining patients was difficult to determine. Our patient presented clinical and histological features of generalized PSS-type A.
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Ictiosis/clasificación , Ictiosis/patología , Adulto , Consanguinidad , Femenino , Humanos , Ictiosis/genética , Síndrome , Transglutaminasas/genéticaRESUMEN
INTRODUCTION: The orf is a zoonotic infection which can be transmitted to humans. OBJECTIVE: The aim of our report is to describe this often misdiagnosed viral infection in a man with an orf of the hand appearing after the feast of the sacrifice. CASE REPORT: A 40-year-old man with no past medical history, presented with a nodular lesion on the fifth right finger evolving for 3 weeks which had appeared 2 weeks after the feast of the sacrifice. Histology showed a vacuolar degeneration of keratinocytes probably of viral origin. Both histological aspect and the contact with sheep, led to the diagnosis of hand orf. Three weeks later the lesion had spontaneously resolved. CONCLUSION: Orf is an infectious mucocutaneous disease due to a parapoxvirus. It is more frequent in professionally exposed persons (veterinary, butchers...). But, in our country, the frequency of the orf increases after the feast of the sacrifice and remains undiagnosed because patients do not consult. The diagnosis may be confirmed by electron microscopy, conventional histopathology or by isolation of the virus by PCR. Information on the benign character of the disease and reassurance of the infected patient are very important because lesion usually resolves spontaneously.