Introduction: In Africa, an increase in the incidence of lupus erythematosus has been noted in recent years. Very few studies have been conducted on epidemiological and clinical aspects of this disease in sub-Saharan Africa. The purpose of this study was to report the epidemiological, clinical and evolutionary aspects of lupus disease in an African Black population. Materials and methods: This was a retrospective cross-sectional study including all cases of lupus seen in two departments of Dermatology in Dakar from 1999 to 2015. Results: Three hundred and forty cases were recorded, corresponding to a hospital frequency of 0.05%. The average age was 33 years. The sex ratio was 0.17. The various manifestations were: dermatological (89.4%), rheumatological (33.2%), cardiac (5.8%), renal (12%), respiratory (5.6%), neuropsychiatric (4.7%), digestive (2.6%), hematological (70%) and immunological (56.2%). Lupus was associated with antiphospholipid antibody syndrome (35%), dermatomyositis (26.3%), rheumatoid arthritis (17.5%) and scleroderma (21%). Patients were treated with corticosteroids (92%), immunosuppressive (12%) and synthetic antimalarial drugs (88.2%). A remission was noted in 80%. The complications were an infection (20.5%) and the occurrence of squamous cell carcinoma (0.8%). Death occurred in 2.6%. Conclusion: Lupus erythematosus is a frequent condition in our regions and represents the first connective tissue disease in our department. Systemic lupus erythematosus is by far the most frequent form, followed by chronic lupus, while subacute lupus seems very rare. The disease is often severe with frequent visceral involvements. The prognosis is still poor in our regions due to the delayed diagnosis with frequent renal involvement and frequent infectious complications.
We report a case of a 28-year-old man with xanthomas over the extensors of the limbs, cataract, chronic diarrhea and various neurological disabilities. There was also an ichthyosis, which predominate over the lower limbs. Chest CTscan showed bilateral apical opacities with cystic images in the culmen. Brain MRI revealed bilateral and symmetric T2 and FLAIR hyper-signals sequences in the region of dentate nucleus and adjacent cerebellar and periventricular white matter. We have reported the first case of CTX in Senegal, which is remarkable by an acquired ichthyosis and excavated lung lesions simulating a tuberculosis.
The occurrence of Pyoderma gangrenosum (PG) during pregnancy or postpartum has rarely been reported. These forms can also occur on a recent scar facilitated by the pathergy phenomenon. A 25-year-old woman showed an abruptly worsening of a post-caesarean wound that evolved rapidly into a painful, purulent, extensive ulcer with breakdown of sutures, along with fever and leukocytosis despite antibiotic therapy. The diagnosis of postoperative PG was evoked on the unusual course of the surgical wound, the existence of old cribriform scars on the legs, the clinical appearance of the ulceration around the surgical incision and confirmed by histology, as well as the favourable outcome under systemic corticosteroid. This case raises once again the issue of the possible relationship between pregnancy and PG. In our case, pregnancy could have triggered the PG, and the Caesarean section facilitated its clinical expression by the pathergy phenomenon. Thus, pregnancy could be in the same way as chronic inflammatory diseases, such as arthritis, inflammatory bowel disease and haematological disorders, a triggering or exacerbating factor of PG.
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