Name
Tuberculose palpébrale survenant sur naevus de panda

Merci de vous identifier pour accéder à ce contenu.

Je me connecte  


Orateurs :
Dr Younes TLEMCANI
Auteurs :
Dr Younes TLEMCANI
Dr Salma HASSINA
Dr Imad LIDYA
Dr Lobna ROBBANA
Dr Mohamed Amine KRICHENE
Dr Badreddine OUBAAZ
Louai Serghini
Dr Elhassan ABDALLAH
Hamani A Berraho
Tags :
Résumé

Objectif

Panda nevus is a very rare congenital periocular nevus. It is characterized by its dark pigmentation and rough surface. The risk of malignant transformation and cosmetic discomfort are the main indications for surgical resection of these lesions. The occurrence of a tuberculous granuloma on this lesion is a rare situation posing the problem of differential diagnosis with its degeneration.

We report the case of a young patient who underwent surgical resection of the lower part of his nevus for suspicion of malignant degeneration and in whom the anatomo-pathological examination of the surgical specimen was in favor of tuberculous involvement. 

Description de cas

This is a 21 years old patient with no notable pathological history except for a right periocular pigmented lesion present from birth.

Observation

Our patient consults for a recent increase in the size of the lower part of this lesion without local or general inflammatory signs. Clinical examination of the appendages found a right periorbital nevus of dark pigmentation, of rough surface with the presence of some hairiness, affecting the two upper and lower right eyelids and the right infraorbital region, giving the appearance of a "nevus of panda". Below the free margin of the lower eyelid the nevus presents a raised ulcerative necrotic area infiltrating the entire eyelid in favor of a malignant transformation. The first biopsy performed was inconclusive, an excisional biopsy of the mass sparing the free margin of the lower eyelid was done with eyelid reconstruction using a flap taken from the inner side of the arm. The anatomo-pathological study revealed the presence of epithelioid cells and giant cells with foci of caseous necrosis in favor of tuberculous disease occurring in a panda nevus.

Retrospective examination did not reveal any known tuberculosis contagion or any notion of palpebral trauma. Somatic examination did not find any evidence for pulmonary or extra-pulmonary tuberculosis involvement. The chest x-ray, complete blood count were normal. The test for Koch's bacillus in sputum and urine was negative. The tuberculin skin test produced an induration of 6 mm. The patient was treated with a combination of four anti-bacillary drugs (Rifampicin, Isoniazid, Pyrazinamide and Ethambutol) for 2 months, then Rifampicin and Isoniazid for 4 months with good progress.

Discussion

Panda nevus are rare benign tumors present from birth They have the particularity of involving both upper and lower eyelids achieving the appearance of an eye covered by the nevus when the eyelid is closed and can be extended, sometimes interesting the cheek, the risk of changing to melanoma depends on the size of the nevus. The peculiarity of this observation lies in the fact that palpebral tuberculosis was diagnosed after resection of the part of the nevus suspected of having degenerated into melanoma by the demonstration of a gigantocellular granuloma with caseous necrosis. In our case, careful somatic and ophthalmologic examination did not find any sign of another location of tuberculosis. Treatment is exclusively medical and involves anti-bacillary chemotherapy.

Conclusion

The clinical polymorphism of cutaneous tuberculosis explains the difficulty of diagnosis. especially when it develops on a benign pre-existing lesion likely to degenerate, because the modification of its appearance, first evokes a malignant transformation. However, the resurgence of tuberculosis should prompt us to mention any atypical palpebral lesion and to perform a biopsy for histological confirmation.