S Bouassida

Hedi Chaker Hospital, Şafāqis, Şafāqis, Tunisia

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Publications (84)39.2 Total impact

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    ABSTRACT: The erysipeloid form of cutaneous leishmaniasis is considered as an unusual and rare clinical presentation in Tunisia. Our prospective study on 4 observations, aimed at examining the clinical, histological and progressive features of the "erysipeloid" form of cutaneous leishmaniasis. Our patients were 3 females and one male more than 62 years old. Their cutaneous leishmaniasis was clinically characterised by an infiltrated and extensive plaque which was localised on the face covering the nose and cheeks looking like erysipelas. The treatment was intramuscular meglumine antimoniate (Glucantime) in three cases and metronidazole in one case. A regression without scar was noticed in all the cases. On the histological examination, we observed an intense epidermic and constant hyperplasia with presence of amastigotes in 3 cases. Our study shows the lesional polymorphism of the old word cutaneous leishmaniasis in our region. The "erysipeloid" form of cutaneous leishmaniasis is a rare clinical presentation which generally affects women. If the clinical aspect is very meaningful, the histological aspect is meaningful but not specific.
    Bulletin de la Société de pathologie exotique 01/2009; 101(5):395-7.
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    ABSTRACT: The hepetiformis impetigo is a pustulosis dermatosis. It is rare and specific to pregnancy. It can menace the prognostic of the mother and the child. This entity is actually considered as a pustulor psoriasis. We report two cases. CASES REPORTS: Two patients, respectively, aged 24 and 21, presented erythematous, pustular and extensive plaques for which the diagnosis of hepetiformis impetigo was clinically and histologically posed. For the first patient, the lesions appeared in the two pregnancies and were more severe and foetal repercussions (oligoamnios and hypotrophy) during the second pregnancy. For the second patient, the pregnancy was complicated with premature interruption of the membrane, giving birth to a deed fetus and causing an aggravation of the cutaneous lesions. The treatment was oral steroid followed by acitretin for the first patient, however, for the second patient; the treatment was by local steroid associated with UVB during the pregnancy. Then, acitrétine was used and was efficient. CONCLUSION: Our two cases show the importance of gynaecological control in order to avoid complications which can be sometimes fatal. They also show the importance of local steroid associated with UVB which constitute another therapeutic alternative in the treatment of hepetiformis impetigo.
    Journal de Gynécologie Obstétrique et Biologie de la Reproduction 12/2008; 37(8):804-7. · 0.45 Impact Factor
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    ABSTRACT: Le terme de sclérodermie réunit un groupe hétérogène de maladies du tissu conjonctif d’étiologie inconnue qui ont en commun une induration de la peau. L’association de sclérodermie et de néoplasie a été rapportée, mais son caractère fortuit ou non reste controversé. Nous rapportons une observation d’association entre une morphée généralisée et un cancer rectal. Mme D.B., âgée de 62 ans, sans antécédents pathologiques particuliers, a été hospitalisée en avril 2005 pour de multiples plaques d’aspect blanc nacré, brillantes, indurées, ne se laissant pas plisser à la palpation, siégeant au tronc et aux racines des membres inférieurs. Ces lésions évoluaient depuis un mois et demi. Le diagnostic de morphée généralisée a été suspecté. La biopsie cutanée a conclu àune sclérodermie. Les anticorps antinucléaires étaient négatifs. La patiente a été mise sous prednisone à la dose de 0,75 mg/kg/j avec une légère amélioration. Pendant son hospitalisation, la patiente se plaignait de constipation et d’une sensation d’un corps étranger intrarectal depuis trois mois. La rectoscopie a montré une volumineuse tumeur rectale. La biopsie rectale a conclu à un adénocarcinome luberkuhnien bien différencié. Cette tumeur rectale a été traitée par radiothérapie associée à une chimiothérapie suivie d’une exérèse chirurgicale. La morphée généralisée a complètement régressé deux mois après l’intervention chirurgicale. L’association de cancer rectal et de morphée généralisée est rare. Il existe beaucoup d’arguments en faveur du caractère paranéoplasique de la morphée généralisée dans notre cas. The term Scleroderma unites a heterogeneous group of disease of conjunctive tissue with, unknown in etiology and wich have together an induration of the skin. The association of the scleroderma and neoplasy were not clearly reported. We report an observation of association between a generalised morphea and a rectal cancer. Ms D.B., aged of 62 years old, with no pathologic antecedents, was hospitalised in 2005 for multiple plaques, white, indurated, and localised in the trunk and the lower extremities. The lesions have evolved for one month and a half. The diagnosis of generalised morphea was suspected. The cutaneous biopsy concluded a scleroderma. The antinuclear antibody (anti-Scl 70) was negative. The patient was treated by prednisone (0,75 mg/kg/day) with a slight amelioration. During his hospitalisation, the patient suffered from constipation and the questionnaire showed a sensation of intrarectal body since 3 months. The rectoscopy revealed a big rectal tumor. The rectal biopsy concluded to differentiated luberkinien adenocarcinoma. This rectal tumor was treated by a radiotherapy associated with chemotherapy then followed by surgery. The morphea worsened 2 months later. The association between the generalised morphea and the cancer is rare. There is many arguments to paraneoplasic character of generalised morphea.
    Oncologie 10/2008; 10(11):673-676. · 0.10 Impact Factor
  • La Tunisie médicale 08/2008; 86(7):724-5.
  • La Tunisie médicale 06/2008; 86(5):512-3.
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    ABSTRACT: Case 1 A 54-year-old woman presented with a 5-month history of an asymptomatic, 2.5-cm, erythematous, ulcerated nodule involving the umbilicus ( Fig. 1). Biopsy demonstrated metastatic adenocarcinoma ( Fig. 2) and abdominal ultrasound showed a large ovarian tumor ( Table 1). Further evaluation revealed pleural metastases. Case 2 A 58-year-old man was hospitalized with a 6-month history of diffuse abdominal pain, a 2-week history of a cutaneous nodule, and a 5-day history of bloody diarrhea. Cutaneous examination revealed a 1.5-cm, erythematous to violaceous, infiltrative, and verrucous nodule of the umbilicus ( Fig. 3). Colonoscopy showed a pedunculated polyp of the right colon and a loss of substance in the anal area; histologic examination demonstrated well-differentiated adenocarcinoma. Abdominal ultrasound showed moderate ascites. A diagnosis of colorectal adenocarcinoma ( Table 1) with umbilical metastasis and peritoneal carcinomatosis was made. Case 3 A 42-year-old man, with a history of surgery 5 months earlier for a perforated gastric ulcer, was hospitalized with a 2-month history of abdominal pain and general deterioration. Clinical examination showed a 15-cm infiltrative area at the central abdomen with coalescing ulcerated papules at the umbilicus ( Fig. 4), which developed during the onset of abdominal pain. Histologic evaluation revealed metastatic adenocarcinoma to the skin. Further evaluation supported a diagnosis of pancreatic cancer with peritoneal carcinomatosis ( Table 1). Case 4 A 58-year-old man presented with a 3-month history of abdominal pain and a 1-month history of a painful, bilobed nodular lesion involving the umbilicus. Clinical examination showed a nontender, uniform, and fixed abdominal mass. Colonoscopy revealed a cecal mass. Histologic examination of the cecal mass and umbilical lesion confirmed a diagnosis of ileocecal sarcoma ( Table 1). Further evaluation demonstrated peritoneal metastases. Case 5 A 58-year-old woman was hospitalized with a 1-year history of an umbilical lesion, abdominal pain, vomiting, and general deterioration. Examination revealed a 2-cm hard, fixed, nontender, umbilical tumor and hepatomegaly. Endoscopy showed a gastric ulcer without histologic evidence of malignancy. Additional evaluation demonstrated a gallbladder tumor, hepatic metastases, and peritoneal carcinomatosis ( Table 1). Biopsy of the umbilical lesion revealed poorly differentiated adenocarcinoma.
    International journal of dermatology 03/2008; 47(2):134-6. · 1.18 Impact Factor
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    ABSTRACT: Actinic lichen planus (ALP) is a chronic and benign disease that affects young people of the Middle East and Maghreb countries. To analyse clinical features and prognosis of ALP in children. A retrospective, descriptive study of cases observed in the department of dermatology of Sfax hospital over a period of 11 years (1995-2005). Our patients were 5 boys and 1 girl. Mean age at diagnosis was 11 years. Onset was during the summer in 5 cases. The face was involved in 5 cases and the upper limb in 3 cases. The annular form was found in 5 cases, the pigmented melasma-like form in 1. Cheilitis was associated in 3 cases. Treatment consisted in photoprotection in all the patients. Antimalaria drugs were used in 4 patients and topical steroids in 2. Evolution was favourable in 5 cases. Disease relapsed in one child after treatment interruption. ALP can be seen during childhood. Ultraviolet rays are involved in pathogenesis. The annular form is predominant. Treatment is based on sun protection associated with antimalarials or topical steroids.
    Archives de Pédiatrie 03/2008; 15(2):111-4. · 0.36 Impact Factor
  • Pigment Cell & Melanoma Research 03/2008; 21(1):106-7. · 5.84 Impact Factor
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    ABSTRACT: Dissemination of cutaneous leishmaniasis may take various forms: satellite papules, sporotrichoid nodules and widespread papulonodular lesions (disseminated cutaneous leishmaniasis). We describe a particular clinical form of dissemination in two patients with erysipelas secondary to lymphoedema. Case 1. A 75-year-old man with diabetes consulted for erysipelas of the leg secondary to lymphoedema. The site of entry was an infected cutaneous leishmaniasis lesion. The initial outcome was favourable under intravenous penicillin G treatment. Twelve days later, some fifty papulonodular lesions appeared and were strictly limited to the erythematous erysipelas plaque. PCR screening of papulonodular lesion smears for Leishman bodies was positive. Histological examination of skin biopsy samples showed lobular panniculitis. Case 2. A 64-year-old woman with diabetes presented erysipelas in the right upper limb secondary to lymphoedema scattered with multiple erythematous, infiltrated, papular lesions in a setting of cutaneous leishmaniasis lesions. PCR analysis of smears taken from the secondary nodular lesions demonstrated the presence of leishmaniasis, while histological analysis of biopsy samples revealed panniculitis. Disseminated cutaneous leishmaniasis is characterized by the appearance of multiple (>10) pleomorphic lesions on two or more noncontiguous areas of the body. Our two patients presented certain features of disseminated cutaneous leishmaniasis. However, they were unusual in terms of the strict localisation of nodular lesions to the erysipelas plaque. This particular aspect suggests haemolymphatic dissemination of the protozoan infection from the initial lesion as a result of local factors.
    Annales de Dermatologie et de Vénéréologie 02/2008; 135(2):123-6. · 0.60 Impact Factor
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    ABSTRACT: The sporotrichoid variety of cutaneous leishmaniasis is defined by the presence of dermal and hypodermal nodules along the lymphatic stream, and remote from the primary inoculation lesions. This clinical form is usually considered rare. The aim of our study was to investigate the epidemiological, clinical, histological and evolutionary particularities of sporotrichoid cutaneous leishmaniasis in the south of Tunisia. During a systematic study of all cases of cutaneous leishmaniasis from the south of Tunisia diagnosed in our hospital in 2002, sporotrichoid forms were diagnosed on the basis of clinical criteria. In all cases of sporotrichoid cutaneous leishmaniasis, the principal clinical characters were systematically specified. Cutaneous biopsies of subcutaneous nodules were performed in six cases. Of 102 patients with cutaneous leishmaniasis, 19 presented sporotrichoid cutaneous leishmaniasis, that is, a frequency of 19%. Between two and 20 painless subcutaneous nodules were arranged in linear strings on the upper leg in 79% of cases. Time to appearance varied between 12 days and one year after the primary lesions. Fourteen appeared without any preliminary treatment for cutaneous leishmaniasis and five appeared after Glucantime infiltration in the primary lesions. Biopsies of the nodules showed an inflammatory infiltrate composed of lymphocytes and histiocytes. This infiltrate was particularly dense and rich in plasmocytes at the level of the deep dermis. The biopsies were deep enough to involve the hypoderm in one case and the same type of infiltrate was noted at the level of interlobular septa. A small number amastigotes was seen in one deep biopsy sample. Outcome was favourable in all cases under treatment. Sporotrichoid cutaneous leishmaniasis appears to be common in the south of Tunisia, were cutaneous leishmaniasis is dominant because of Leishmania major. It is not associated with a poor prognosis.
    Annales de Dermatologie et de Vénéréologie 02/2008; 135(1):63-7. · 0.60 Impact Factor
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    ABSTRACT: Background Dissemination of cutaneous leishmaniasis may take various forms: satellite papules, sporotrichoid nodules and widespread papulonodular lesions (disseminated cutaneous leishmaniasis). We describe a particular clinical form of dissemination in two patients with erysipelas secondary to lymphoedema. Patients and methods Case 1. A 75-year-old man with diabetes consulted for erysipelas of the leg secondary to lymphoedema. The site of entry was an infected cutaneous leishmaniasis lesion. The initial outcome was favourable under intravenous penicillin G treatment. Twelve days later, some fifty papulonodular lesions appeared and were strictly limited to the erythematous erysipelas plaque. PCR screening of papulonodular lesion smears for Leishman bodies was positive. Histological examination of skin biopsy samples showed lobular panniculitis. Case 2. A 64-year-old woman with diabetes presented erysipelas in the right upper limb secondary to lymphoedema scattered with multiple erythematous, infiltrated, papular lesions in a setting of cutaneous leishmaniasis lesions. PCR analysis of smears taken from the secondary nodular lesions demonstrated the presence of leishmaniasis, while histological analysis of biopsy samples revealed panniculitis. Discussion Disseminated cutaneous leishmaniasis is characterized by the appearance of multiple (> 10) pleomorphic lesions on two or more noncontiguous areas of the body. Our two patients presented certain features of disseminated cutaneous leishmaniasis. However, they were unusual in terms of the strict localisation of nodular lesions to the erysipelas plaque. This particular aspect suggests haemolymphatic dissemination of the protozoan infection from the initial lesion as a result of local factors.
    Annales De Dermatologie Et De Venereologie - ANN DERMATOL VENEREOL. 01/2008; 135(2):123-126.
  • Oncologie. 01/2008; 10(11):673-676.
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    ABSTRACT: Zoonotic cutaneous leishmaniasis (CL) is characterised by a major clinical polymorphism, especially the lupoid type. The aim of our study was to precise the anatomic and clinical particularities of this clinical form of CL. The present work was a prospective 1-year study. In all patients, the epidemiologic and clinical characteristics were identified, together with those regarding disease progression. Standard cutaneous biopsies were carried out for all study patients. The lupoid form was observed in 15% of the patients. It was clinically characterised by a lupoid aspect with papular and squamous placard surrounded by a satellite papule, a short duration of disease progression (28 months in average) and a preferential localisation at the level of the face and the elbow, statistically proven. At the histological level, epidermic hyperplasia was found in 93.8% of the cases; an inflammatory polymorphic dermic infiltrate consisting of lymphocytes and plasmocytes was found in all patients; granulomas were noted in 50% of the cases, and isolated epitheloid cells were observed in the derm of 3 patients. Amastigotes were rarely observed. In our series, the lupoid form was characterised with a short and non chronic evolution and two preferential sites for the affection: the face and the elbow. At the histological level, the lupoid type of CL appeared characterized by a high frequency of granuloma, usually organized, and rare amastigotes. However, the histology of authentic lupoid forms can be non granolomatosic.
    La Presse Médicale 01/2008; 36(12 Pt 1):1738-42. · 0.87 Impact Factor
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    ABSTRACT: Background The sporotrichoid variety of cutaneous leishmaniasis is defined by the presence of dermal and hypodermal nodules along the lymphatic stream, and remote from the primary inoculation lesions. This clinical form is usually considered rare. The aim of our study was to investigate the epidemiological, clinical, histological and evolutionary particularities of sporotrichoid cutaneous leishmaniasis in the south of Tunisia.Patients and methodsDuring a systematic study of all cases of cutaneous leishmaniasis from the south of Tunisia diagnosed in our hospital in 2002, sporotrichoid forms were diagnosed on the basis of clinical criteria. In all cases of sporotrichoid cutaneous leishmaniasis, the principal clinical characters were systematically specified. Cutaneous biopsies of subcutaneous nodules were performed in six cases.ResultsOf 102 patients with cutaneous leishmaniasis, 19 presented sporotrichoid cutaneous leishmaniasis, that is, a frequency of 19%. Between two and 20 painless subcutaneous nodules were arranged in linear strings on the upper leg in 79% of cases. Time to appearance varied between 12 days and one year after the primary lesions. Fourteen appeared without any preliminary treatment for cutaneous leishmaniasis and five appeared after Glucantime® infiltration in the primary lesions. Biopsies of the nodules showed an inflammatory infiltrate composed of lymphocytes and histiocytes. This infiltrate was particularly dense and rich in plasmocytes at the level of the deep dermis. The biopsies were deep enough to involve the hypoderm in one case and the same type of infiltrate was noted at the level of interlobular septa. A small number amastigotes was seen in one deep biopsy sample. Outcome was favourable in all cases under treatment.Conclusion Sporotrichoid cutaneous leishmaniasis appears to be common in the south of Tunisia, were cutaneous leishmaniasis is dominant because of Leishmania major. It is not associated with a poor prognosis.
    Annales de Dermatologie et de Vénéréologie 01/2008; 135(1):63-67. · 0.60 Impact Factor
  • Annales de Dermatologie et de Vénéréologie 12/2007; 134(11):871-2. · 0.60 Impact Factor
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    ABSTRACT: Sexual disturbances after colostomy are various. However, they probably remain underestimated in societies where sexuality is still a taboo issue. THE AIM of this prospective study was to evaluate the possible sexual behaviour and the post operative sexual disturbances in patients whome underwent colostomy. The group was devided in 10 male and 11 female patients. Seventeen patients (81%) were married, 3 widowed and 1 unmaried. Sexual disturbances were found in 47% of patients. There was a lack of interest in sexual relations in 2 women, a resolved premature ejaculation in one case, post operative dysparenia in 2 female patients, a retrograde ejaculation in a 60-year-old man, impotence in a 46 years old patient, and a premature ejaculation in a 36-year-old man. The frequency of sexual disturbances (47%) in our series was close to that reported in the literature (50%). The sexual disorders are more common in male patients, the most frequent being ejaculatory dysfunction. In women, dyspareunia is the most common disorder. The particular case of colostomy in homosexuals remains a current issue.
    La Tunisie médicale 08/2007; 85(7):537-40.
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    ABSTRACT: Skin cancer (SK) frequency is increasing all over the world. We report a clinical and epidemiological study of SK in the south of Tunisia through a 1476 cases series. On the basis of a retrospective study, we report the clinical and epidemiological data collected from files of patients with skin cancers seen during a 24-year-period (1979-2002). Our series was composed of 1476 patients, with an incidence of 615 cases/year. The mean age was 55 years. Epithelial skin carcinomas were the most common (1288 cases, 87.3%). Basal cell carcinomas were found in 890 patients (69%) and squamous cell carcinomas in 398 (31%). The mean age was 60 years. The phototype III was the most common (52.8%) among these patients. Skin melanomas were found in 71 cases (4.8%). The mean age was 54 years with a female predominance (60.6 %). Kaposi sarcoma was found in 4.5% of patients. The mean age was 64.3% and a male predominance was found (80% of cases). Two patients with Kaposi sarcoma (33%) were HIV positive. Dermatofibrosarcoma protuberans was reported in 2% of patients and skin lymphoma in 1.7%. The mean age is relatively low in our series. The increase in the incidence of skin cancers is probably related to the climatic conditions, the ageing of the population and to the changes in the social, economic and cultural aspects in the country. The male predominance is changing toward an equal distribution between both sexes probably in relation to the present similarity in the life style and work conditions.
    La Tunisie médicale 07/2007; 85(6):505-8.
  • M Mseddi, S Bouassida, H Turki
    Annales de Dermatologie et de Vénéréologie 06/2007; 134(5 Pt 1):500-1. · 0.60 Impact Factor
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    ABSTRACT: Sweet syndrome is the most common neutrophilic dermatosis. We studied its natural history and epidemiologic, clinical, and therapeutic characteristics from a series of 54 cases. This retrospective study examines 54 cases collected over a 10-year-period. Diagnosis was based on clinical and histological criteria. Patients' mean age was 47 years. The sex ratio was 8 women for every man. Disease developed most often in autumn and onset was sudden in all patients. Untypical aspects were found in 20 patients. Lesions were located mainly on the arms (43 cases) and legs (33 cases). No mucous membrane involvement was observed. Histological testing found leukocytoclastic vasculitis in 8 cases. Sweet syndrome was idiopathic for 38 patients. Lesions began at the site of previous trauma for 9 patients, occurred during pregnancy for 2, and were associated with cancer for 3. First-line treatment was colchicine for 23 patients and oral steroids for 12. Six patients had recurrences and 2 patients had relapses. This large series of patients with Sweet syndrome differs from other reports by the frequency of untypical aspects and post-traumatic forms, as well as the rarity of association with cancer. Histological findings of vasculitis do not rule out a diagnosis of Sweet syndrome.
    La Presse Médicale 04/2007; 36(3 Pt 1):419-24. · 0.87 Impact Factor
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    ABSTRACT: Subacute cutaneous lupus erythematosus is extremely rare in childhood. We report the case of a 7 year-old girl who presented annular erythematous infiltrated lesions on sun exposed areas since the age of 2 months. Histopathologic examination showed orthohyperkeratosis, epidermal atrophy, widespread hydropic degeneration of epidermal basal cell layer, and a dermal lymphohistiocytic infiltrate. The lupus band test was negative. The immunological investigations (antinuclear antibodies) were negative. Treatment with antimalarials, topical steroids and sun protection allowed clearance of the cutaneous lesions. Lesions relapsed after antimalarials discontinuation and sun exposure. Four years later, at the age of 11, the antinuclear antibodies became positive. The diagnosis of subacute cutaneous lupus erythematosus is based on the clinical aspect of lesions, topography, histological finding, evolution and immunological profile of the patient.
    Archives de Pédiatrie 03/2007; 14(2):164-6. · 0.36 Impact Factor