[Acute onset Hodgkin's disease following Lyell's syndrome]

BACKGROUND

In most cases, toxic epidermal necrolysis is a drug-induced reaction. Other causes such as lymphomas have also been suspected. We report herein a new association of toxic epidermal necrolysis and Hodgkin's disease in a male patient.

CASE REPORTS

A 62-year-old man consulted for erythroderma, scalded skin and mucous erosions involving the oral, nasal and genital areas. Nikolsky's sign was present. Cutaneous biopsy confirmed the diagnosis of toxic epidermal necrolysis. Our patient acknowledged intake of fexofenadine 48 hours before the eruption. He also developed enlarged lymph nodes whose histopathological examination revealed Hodgkin's disease. Exploration of cytolytic hepatitis disclosed replicating chronic viral B hepatitis. The skin disorder quickly improved and our patient underwent CHOP chemotherapy.

DISCUSSION

Association of toxic epidermal necrolysis and lymphoproliferative disorders has been reported. Development of toxic epidermal necrolysis is normally related to administration of antineoplastic drugs. However, lymphomas may be diagnosed after the onset of toxic epidermal necrolysis in the absence of drug intake, pointing to a possible aetiological role of haematological disease in the development of toxic epidermal necrolysis.

Kawasaki-like syndromes in HIV-infected adults

BACKGROUND

Kawasaki-like syndrome (KLS) is rare in adults; one third of these patients are infected by Human immunodeficiency virus (HIV). Our study reports cases of KLS occurring in HIV-positive adults and reviews the literature to compare their characteristics with HIV-negative adults and children with Kawasaki disease (KD).

METHODS

Report of cases and review of the literature.

RESULTS

Amongst 20 cases reviewed, including 4 who were managed at our institution, KLS was associated with severe immunosuppression and a high HIV viral load. There was frequent co-infection by hepatitis viruses. Desquamation and liver abnormalities were more frequent in HIV-negative adults whereas headaches and gastrointestinal disorders more common in HIV-positive adults. Intravenous immunoglobulin was effective therapy. Relapse was more frequent among HIV-positive patients. No cardiovascular complications or deaths occurred.

CONCLUSIONS

Advanced immunosuppression due to HIV may predispose to KLS. The differential diagnosis that must be considered includes drug hypersensitivity reactions and staphylococcal infections.

Complications musculo-squelettiques du syndrome de Werner

INTRODUCTION

Werner's syndrome, a rare autosomal recessive genetic disease, is a premature aging disease characterized by early onset of symptoms related to normal aging including short stature, cataracts, graying of the hair, skin ulcerations, diabetes, osteoporosis, atherosclerosis and predisposition to cancer. Musculoskeletal complications can also develop with major impairment of quality of life for these patients.

OBSERVATION

We report two typical cases in two males aged 47 and 44 diagnosed on the basis of cutaneous progeroid signs. Diagnosis was confirmed by identification of homozygotous mutations in the WRN gene. The first patient later developed chronic osteomyelitis of the right forearm, which is a rare complication of Werner's syndrome. The second patient presented calcaneum valgus resulting in mechanical overwork and bilateral posterior tibial tendinitis. He also developed osteitis of the 5th toe.

CONCLUSION

Dermatologists should be aware of the potential orthopedic complications of this disease in order to diagnose them as quickly as possible and organize multidisciplinary management alongside other specialists such as rheumatologists and orthopedic surgeons.

Syndrome de Werner (progeria de l’adulte)

Werner's syndrome (adult onset progeria) is a rare form of autosomal recessive genodermatosis associated in almost 80% of cases with mutation of the WRN gene. This prototype of rapid ageing syndromes is characterized by short stature with skin and hair anomalies (early graying of the hair, alopecia, depilation, sclerosed skin), orthopedic complications (flat foot, hallux valgus and other joint deformations) as well as systemic signs (early cataract, premature and diffuse atherosclerosis, endocrinopathies) and high risk of certain types of cancer (sarcomas, myeloid blood dyscrasias). Death occurs around the age of 40 - 50 years mainly as a result of cardiovascular accident or development of a malignant tumour. Signs of early aging should evoke this basic diagnosis and arrangements should be made for appropriate follow-up with screening for and treatment of systemic complications.

Chronic cutaneous lupus flare induced by systemic 5-fluorouracil

5-Fluorouracil is an antineoplastic antimetabolite responsible for a variety of cutaneous reactions. We report a case of chronic cutaneous lupus flare related to systemic 5-fluorouracil administration for breast cancer in a patient with documented history of chronic cutaneous lupus.

Syndrome macrocéphalie-cutis marmorata telangiectatica congenita

BACKGROUND

Macrocephaly-cutis marmorata telangiectatica congenita is a multiple congenital anomaly/mental retardation syndrome described in 1997 in children with macrocephaly, cutis marmorata telangiectatica congenita and several other abnormalities.

CASE REPORT

A six month-old boy was seen for hyperplasia of the right side of the body. Clinical examination disclosed overgrowth, macrocephaly, a generalized reticulated, blue-violet vascular network, partial bilateral syndactyly between the 2nd and 3rd toes, and several superficial capillary malformations. Psychomotor development was normal. Brain MRI showed enlargement of the right lateral ventricle and hemisphere in relation to the left side but without malformation. Radiological examination of the skeleton showed asymmetry of the limbs.

DISCUSSION

The patient reported herein presented macrocephaly-cutis marmorata telangiectatica congenita syndrome characterized by macrocephaly and more than two of the main reported findings comprising cutis marmorata, superficial vascular anomaly, syndactyly and asymmetry. We set out the major components of this polymalformative syndrome that are rarely reported in the dermatologic literature.

[Eruptive pseudoangiomatosis in infant and newborns]

INTRODUCTION

Eruptive pseudoangiomatosis was first described in children in the form of an acute non-pruritic macular or papular rash that fades on application of a glass test and resolves within several days. Viral aetiology is suspected but has never been demonstrated to date.

OBSERVATIONS

We discuss seven cases of infants presenting this disease: 5 boys and 2 girls aged 8 days to 16 months. The rash presented typical clinical features in all cases and affected the face and limbs in 6 of the 7 subjects. In one child, involvement of the face and back was observed with sparing of the limbs. The rash occurred after an episode of rhinolaryngeal infection in 3 cases and after gastrointestinal infection in 1 case. Spontaneous resolution was seen within 3 to 10 days in 6 patients although a longer course lasting over 9 months was observed in one infant. In another patient, the rash appeared after surgery for mesoblastic nephroma. In one child, a similar rash was seen in both parents. Screening for infectious agents was negative for the two children from whom samples were obtained.

DISCUSSION

This series of paediatric cases of eruptive pseudoangiomatosis is characterised by the very young age of one of the children, coexistence of the condition with a renal tumour in another child, the familial nature of the rash in a third child and unusually long disease duration in the final child. However, this series did not allow identification of the causative infectious agent or agents. Probably, as with other syndromes such as Giannotti-Crosti syndrome or "gloves and socks" syndrome, eruptive pseudoangiomatosis forms a clinical picture common to a non-specific viral infection.

The presence of dominant T-cell clones in peripheral blood of patients with collagen vascular disorders: a prospective study of 97 cases

BACKGROUND

T-lymphocyte dysfunction has been seldom investigated in collagen vascular disorders. The search for dominant T-cell clones has been scarcely reported, although the presence of such clones might be expected in disorders showing immune responses directed against a variety of autoantigens.

OBJECTIVES

We conducted a systematic search for dominant T-cell clones in peripheral blood in patients with collagen vascular disorders. Patients and methods Ninety-seven patients with collagen vascular disorders were studied (7 cutaneous and 38 systemic lupus erythematosus; 8 multiple morphea; 12 regional scleroderma; 32 systemic sclerosis of the CREST type). A dominant T-cell clone was searched for in peripheral blood by polymerase chain reaction targeting the T-cell receptor gamma chain followed by a size analysis of amplified fragments. Peripheral blood from patients with nonlymphocyte-dependent disorders and matched by age and sex was assessed in the same conditions. Results in both groups were compared using nonparametric statistical tests.

RESULTS

Overall, a circulating dominant T-cell clone was found in 52% of patients compared with 16.9% in controls. More precisely, such a dominant clone was present in 43% and 37% of cutaneous and systemic lupus erythematosus, respectively, in 75% of multiple morphea, 75% of regional scleroderma and 60% of CREST syndrome patients. The percentages in all subsets of patients were significantly higher than in the control group.

CONCLUSIONS

The presence of a dominant T-cell clone in peripheral blood is significantly more frequent in collagen vascular disorders than in controls, especially in patients with scleroderma, whatever the clinical subset, which suggests T-cell involvement in the immune response dysfunction in these diseases classically characterized by disturbances of B lymphocytes. The relevance of such a dominant clone regarding diagnosis, pathomechanisms, long-term outcome and visceral prognosis of these diseases as well as therapeutic decisions remains to be evaluated.

Mucocutaneous side effects of antineoplastic chemotherapy

All structures of the skin may be affected by side effects of antineoplastic chemotherapy. The most commonly described effects concern skin adnexes, especially hair with alopecia. Nails are also frequently involved. Eccrine sweat or sebaceous gland involvement is more rarely reported. Mucous membranes, particularly in the mouth, are frequently altered by several mechanisms; direct cytotoxicity, infection, and a decrease in polymorphonuclear or platelet counts. Among cutaneous side effects, hyperpigmentation is very common and may have different clinical patterns; generalised, figurated, or localised. Acral erythema is another cutaneous side effect that is relatively specific to chemotherapy and is often dose-related. Some cutaneous side effects are related to an interaction between chemotherapy and radiation, particularly phototoxicity, recall phenomenon, and radiation enhancement. Miscellaneous, less frequent, side effects are described; sclerodermiform dermatitis, Raynaud's phenomenon, and hypersensitivity syndrome. In some cases, cutaneous side effects are relatively specific to one type of drug. Capillary leak syndrome is most often related to taxanes. Hydroxyurea is responsible for some peculiar cutaneous side effects (ulcerations, pseudo-dermatomyositis), perhaps due to long-term administration of the drug. Although mucocutaneous side effects of chemotherapy are frequent and sometimes severe, interruption of the culprit drug is rarely mandatory. However, adaptation of the dosage or prevention of some of these side effects remains necessary. Antineoplastic chemotherapies are widely used in many therapeutic protocols and may be responsible for numerous mucocutaneous side effects, either specific or more unusual. In rare cases, the severity of these side effects may require interruption of therapy. They may involve skin adnexes, mucous membranes or the skin itself. This review discusses cytotoxic antineoplastic drugs only, not cytokines, monoclonal antibodies or transduction factors used in the treatment of cancer.