[Fibrillin network in normal bone tissue]

The molecular basis for Marfan's syndrome is known to reside in mutations in FBN1, the gene for fibrillin 1. The skeletal manifestations of Marfan syndrome include morphologic abnormalities and osteopenia. Presence and distribution of fibrillin 1 in adult bone (healthy or with Marfan syndrome) has not been studied extensively. We evaluated distribution of fibrillin and type III collagen in bone and cartilage of children and adults without bone disease, using monoclonal antibodies. Fibrillin is mostly present in attachment sites for tendons. In cartilage and bone tissue, fibrillin is identified at the junction between cartilage and bone in children, and in the areas with intense osteoblastic activity. These data suggest participation of fibrillin in bone formation and growth during youth and in bone mineralisation in adult.

[Pili multigemini: a pilar dysplasia with linear disposition]

BACKGROUND

Pili multigemini is an uncommon pilar dysplasia with linear disposition which could be explained by the pattern of Blaschko's lines.

CASE REPORT

A 37-year-old man with no medical history developed pili multigemini over a heavily bearded chin.

DISCUSSION

Mili multigemini is an uncommon developmental defect of hair follicles resulting from hairs with multiple matrices and papillae emerging through a single pilosebaceous canal. This defect has a linear distribution on the chin we found to follow Blaschko's lines. Pili multigemini has been observed in association with a few rare malformations. Treatment is difficult.

Magnetic resonance imaging changes in periarticular soft tissues during flares of medial compartment knee osteoarthritis. Preliminary study in 10 patients

OBJECTIVE

To quantify changes in magnetic resonance imaging signals from the deep and superficial capsulo-ligamentous planes and the medial collateral ligament in flares of knee osteoarthritis.

PATIENTS AND METHODS

Preliminary prospective study of ten patients with medial compartment knee osteoarthritis meeting American College of Rheumatology criteria and associated with a Lequesne index of 5 or more. A grid was used to evaluate signal changes as compared to the opposite (asymptomatic) knee. Magnetic resonance images were read independently by two radiologists blinded to clinical data.

RESULTS AND DISCUSSION

In all ten patients the capsulo-ligamentous planes and medial collateral ligament generated low signal on T1 images and high signal on T2 images. No significant changes were seen in the asymptomatic knee. The evaluation grid produced satisfactory interobserver agreement.

CONCLUSION

Flares of medial compartment knee osteoarthritis are associated with changes in magnetic signal as compared to the contralateral asymptomatic osteoarthritic knee. The grid developed for this study could be used to evaluate the effects of treatment in a larger number of patients.

[Neonatal toxic erythema: 3 atypical cases]

Diagnosis of pustular dermatosis occurring during the first days of life is based on clinical findings. Erythema toxicum neonatorum (ETN) is the more frequent benign self limiting eruption in the newborn.

CASE REPORTS

Three cases of ETN with localized pustules to the genitals and perineal area are described.

COMMENT

When encountering a newborn with a localized pustulosis rash, it is important to separate benign condition as ETN from those that require prompt diagnosis and therapy. Atypical ETN and pustular dermatosis due to bacterial or viral infections or inflammatory diseases (e.g., eosinophilic pustulosis) can be differentiated by cytological and bacterial samples.

Numerous and large Bier's spot associated with pregnancy

We report a patient with anemic macules over cyanotic skin which started in the 8th month of a normal pregnancy. We thought that these lesions were close to Bier's spot description although it has never been described during pregnancy. The relationship with pregnancy is likely because skin lesions regress in post-partum. It probably represents an exaggerated physiological response of small vessels to venous hypertension observed during pregnancy in predisposed women.

Bone mineral density in sixty adult patients with Marfan syndrome

Sixty adult patients (40 women, 20 men) with Marfan syndrome (MFS) according to the Berlin criteria had a full clinical examination and bone mineral density (BMD) measurement by dual-energy X-ray absorptiometry of the hip and nondominant forearm. BMD was expressed as a Z-score and compared with the reference population of the Hologic database. In MFS men, BMD (g/cm(2)) was compared with the BMD of 45 normal tall Caucasian adults. Osteocalcin was measured by radioimmunoassay. In patients with MFS, BMD was compared between patients with and without previous fractures and according to the phenotypic severity of MFS. The mean age of the patients was 32.9 +/- 9.3 years (women 32.5 +/- 9.7, men 33.4 +/- 8.6), mean height was 180.3 +/- 10.3 cm (women 176.3 +/- 9.2, men 188.1 +/- 7.5) and mean body mass index 20.9 +/- 3.6 kg/m(2) (women 20.8 +/- 3.4, men 20.95 +/- 3.97). Hyperlaxity score (Beighton criteria) was 6.9 +/- 1. 1. Six patients (10%) had a previous fracture. Thirty per cent of patients had had at least one previous operation for scoliosis, aortic dilatation or eye problems. BMD values in the 60 patients were as follows: Z-score of the hip, -1.26 +/- 0.93, p<10(-9) (neck, -0.93 +/- 1.09, p<10(-9); trochanter, -1.31 +/- 0.85, p<10(-9); intertrochanter, -1.39 +/- 0.99, p<10(-9); Ward's triangle, -0.93 +/- 1.88, p<10(-9)); Z-score of the radius: -1.6 +/- 1.06, p<10(-9) (1/3 proximal, -1.29 +/- 1.03; mid-radius, -1.94 +/- 1.04; ultradistal, -0.68 +/- 1.1, p<10(-9)). The decrease in BMD was similar in men and women at both the hip and the radius. BMD in MFS patients was significantly decreased at cortical compared with trabecular sites (radius 1/3 proximal vs ultradistal, p<0.0001; total femur vs Ward's triangle, p<0.0005). No difference in BMD was found between MFS patients with or without previous fractures and those with severe or less severe phenotypic expression of MFS. An influence of height and weight in MFS on BMD is suspected. Osteocalcin was not increased in our group of MFS patients. Thus both men and women with MFS have a significant deficit of BMD at the hip and radius. The decrease in BMD is present equally in both sexes and is more pronounced at predominantly cortical sites. In our group of patients we found no increase in fractures and no relation between decreased BMD and phenotypic expression of the syndrome.

[Universal dyschromatosis: a familial case]

INTRODUCTION

Universal dyschromatosis is a generalized leucomelanodermia recognised in Japan in 1933. We report a family with universal dyschromatosis, demonstrating the mode of transmission. The ultrastructural aspects are compatible with a functional melanogenesis anomaly.

CASE REPORT

A 9-year-old girl was hospitalized for recently diagnosed insulin-dependent diabetes mellitus. She was born to non-consanguinous parents and her past medical history was uneventful. Her father was of mixed ethnic origin. The physical examination revealed generalized leukomelanoderma identified since the first year of life. Zones of small achromatic maculae alternated with zones of pigmented maculae of variable size and color. Lesions were diffuse but predominated on the trunk and did not involve the face, the hands or the feet. Neither the child nor her father who also has leukomelanoderma were photosensitive. A skin biopsy from the gluteal region revealed alternating zones of hyper- and hypopigmentation. The ultrastructural analysis showed that the number of melanocytes was not significantly different in the different pigmented zones and the pigment transfer to adjacent keratinocytes was intact. There were three other girls in the kinhood and two, as well as a few other individuals in the family, had a localized form of the disease.

DISCUSSION

Universal dyschromatosis is a rare genodermatosis. The familial cases reported here illustrate the variable clinical presentations of this pigmentary abnormality. The pedigree in this family demonstrated incomplete penetrance of hereditary leukomelanoderma with autosomal dominant inheritance. The localized forms reported to date under different names would actually appear to correspond to incomplete expression of the dermatosis. The skin manifestations in universal dyschromatosis would appear to be similar to those in a few other skin diseases, mainly xeroderma pigmentosum, especially the localized forms; for generalized forms however, there is little room for confusion as photosensitivity is absent and lesions predominate in unexposed zones. The ultrastructure investigations showed different levels of melanocyte activity without abnormal pigment production or transfer. This abnormality has variable expression, explaining the multitude of clinical presentations.

[Methi-resistant Staphylococcus aureus myositis]

INTRODUCTION

Pyomyositis are relatively rare in our countries.

CASE REPORT

A 73-year-old-man presented with leg pains and septicemia. Diagnosis of pyomyositis was made and a large incision was performed after which the patient had a progressive improvement.

DISCUSSION

Diagnosis of pyomyositis may be difficult in early stages. Diagnosis is greatly facilitated by magnetic resonance imaging. Responsibility of Staphylococcus aureus in cases of pyomyositis due to methi-resistant Staphylococcus aureus may be evocated even if patients was not hospitalized.

[Self-induced cutaneous lesions in Prader-Willi syndrome]

INTRODUCTION

The Prader-Labhart-Willi syndrome was first described in 1956. Prader-Labhart-Willi syndrome is the most common genetic form of human obesity and the incidence of Prader-Labhart-Willi syndrome has been estimated to 1 in 10,000 or 25,000 live births. Skin-picking was frequently reported in Prader-Labhart-Willi syndrome and two patients who displayed repetitive skin picking are described.

OBSERVATIONS

Two childrens (6 year-old girl and 7 year-old boy) were examined and noted superficial ulcers of their arms and legs. This cutaneous lesions were induced by children themselves. Skin-picking, in our cases, were associated with behavior problems (temper tantrums, violence).

CONCLUSIONS

Skin-picking appears to occur in the great majority of patients with Prader-Labhart-Willi syndrome and constitutes a minor criteria of diagnosis. Hypopigmentation in Prader-Labhart-Willi syndrome appears to be as common as previously features. Significant differences in hair color, sun sensitivity and complexion were found between those patients with chromosome 15 deletion and those with normal chromosome. Association between obesity (onset before 6 years) and skin picking constitute a sign for diagnosis of Prader-Labhart-Willi syndrome.

Shaving: a simple and effective treatment for moderate congenital hypertrichosis

Congenital hypertrichosis is a rare disorder. It is sometimes associated with facial dysmorphism, and dental and gingival abnormalities. This condition constitutes an esthetic problem and regular shaving with a simple razor can be a simple method of treatment.

[Cutaneous semiology of febrile rashes in children]

Generalized eruptions with fever are a frequent problem in paediatric practice. Clinical type of skin lesions, distribution and associated signs and symptoms are sometimes specific enough for a definitive diagnosis. However non specific clinical findings do not allow an aetiologic conclusion in some instances. More than 50 infectious agents, drugs and numerous inflammatory diseases are known to cause rashes in childhood.

Facial edema and giant cell arteritis

Many atypical manifestations that can be inaugural in giant cell arteritis are well known. Three cases with facial edema as the first manifestation are described. Similar cases reported to date are reviewed.

[Deep morphea-type lesions, first manifestations of lymphocytic lymphoma]

INTRODUCTION

The association between scleroderma and lymphoma is uncommon and can sometimes query an fortuitous association. More particular are observations where chronological and histological features show an evident link between a tumorous process and sclerosis.

OBSERVATION

This case concerns a man 69 years old who was treated for one year for partial subcutaneous sclerosis present on his legs, thighs, fore-arms, and on the upper part of the trunk. No signs were present of visceral involvement evoking a systemic scleroderma and histology showed an intrication of a deep sclerosis, fasciitis and a tumoral lymphoma process. Diagnosis of lymphocytic lymphoma was confirmed. Initiating a chemotherapy (CHOP) allowed for a reduction of the sclerosis which didn't respond to the only corticotherapy.

DISCUSSION

This observation can be linked to the association of fasciitis and lymphoma identified by Naschitz et al, but is different by: 1) the clinical aspect which correspond more to deep morphea lesions; 2) the histological link between sclerosis and lymphoma. This last point suggest that it is the tumoral population which have induced the sclerosis process linked to the secretion of pro-inflammatory factors. In adverse cases with longer delay between lymphoma and scleroderma this association may be fortuitous.

[Idiopathic eruptive macular pigmentation]

BACKGROUND

Hyperpigmentation can be due to different cause or have no apparent cause.

CASE REPORT

A 4 year-old boy was examined because pigmentation had appeared 5 months earlier. The cutaneous lesions were blue-grey, macular (diameter: 2-3 cm), with a predilection for the trunk, the lower part of the neck and the proximal part of the legs. There was no pruritus and the lesions did not urticate when rubbed. Histologically, there was epidermal acanthosis, moderate hyperkeratosis and dermal infiltration with numerous melanophages. The clinical lesions remained stable 6 months later.

CONCLUSION

The cutaneous manifestations and their course are similar to those of idiopathic macular pigmentation usually reported in adolescents. Ultramicroscopic findings have led some authors to classify it as lichen planus.