[Use of targeting therapy in Erdheim-Chester disease: A case report with neurologic involvement]

INTRODUCTION

Erdheim-Chester disease (ECD) is a rare multisystemic disease characterised by an infiltration of various organs by CD68⁺ CD1a^- histiocytes. The clinical and radiological presentation is very variable.

CASE REPORT

We report the case of a 71-year-old woman with ECD which was revealed by neurological and cutaneous manifestations. The diagnosis was confirmed by skin biopsy and the BRAFV600E mutation was identified in skin tissue, leading to the use of combined therapy targeting the RAS-RAF-ERK-MEK pathway. This therapy allowed an improvement of cutaneous manifestations but neurological manifestations lead to death, underlying their notable severity.

CONCLUSION

Our case report shows the persistent diagnostic difficulty of the ECD and the particular gravity of neurologic involvement.

[Misdiagnosis of hidradenitis suppurativa continues to be a major issue. The R-ENS Verneuil study]

OBJECTIVE

To provide physicians with an understanding of the factors behind significant delays in the diagnosis of hidradenitis suppurativa (HS) in France.

PATIENTS AND METHODS

This prospective multicentre national study conducted from October 2015 to March 2016 included all patients consulting for HS. Patient data were collected by means of a standardized questionnaire. Univariate and multivariate analyses were conducted to collect factors associated with a significant time to diagnosis of at least 5.5years, defined as the period between the onset of initial clinical signs and the time of formal diagnosis.

RESULTS

The 16 participating centres enrolled 312 patients (62% women), of average age 35years. The average age at onset of HS was 22years. Before formal diagnosis by a dermatologist (64% of cases), 170 (54%), 114 (37%) and 45 (15%) patients had previously consulted at least 3, 5 and 10 general physicians, respectively. The average time between the initial clinical signs of HS, the first dermatology visit and the definitive diagnosis was 6.2 and 8.4 years, respectively. Active smoking (OR adjusted 1.85; P=0.027) and disease onset at a younger age (adjusted OR 0.92; P<0.001) were both associated with significant delays in diagnosis.

CONCLUSION

These results emphasized misdiagnosis among HS patients but did not evidence any association between either sociodemographic or economic characteristics and the existence of significant times to diagnosis.

[Lymphangioma with epithelial hyperplasia included in a Bardet-Biedl syndrome]

INTRODUCTION

The Bardet-Biedl syndrome is a rare autosomal recessive disorder, which associates obesity, pigmentary retinopathy, hexadactyly, hypogenitalism, renal dysfunction and mental retardation. Other abnormalities can be observed in the Bardet-Biedl syndrome, but few cutaneous abnormalities have been described.

CASE REPORT

A 41 year-old woman, suffering from a Bardet-Biedl syndrome diagnosed when she was 7 Years old, presented with an atypical pseudo verruca-like, dark red lesion of the interbuttock area that had developed over fifteen Years and had become a handicap. The histological examination revealed a double component: epithelial, papillomatous and acanthosic on the one hand and vascular and lymphatic on the other, suggesting a lymphangioma with epidermal hyperplasia. Magnetic resonance imaging of the sacral area revealed a median subcutaneous lesion, extending deeply to the third coccygial vertebra.

DISCUSSION

Such a lymphangioma is unusual. Because it occurred during a rare polymalformative syndrome, we suggest that it may represent a new clinical sign that can be observed during the Bardet-Biedl syndrome.

[Trumpet nail deformity during the course of Dowling-Meara type epidermolysis bullosa simplex. A report of two cases]

INTRODUCTION

We report two patients with Dowling-Meara type epidermolysis bullosa simplex: who had trumpet nail deformity.

CASE REPORTS

Two 75 and 72 year-old sisters, had flare-ups of epidermolysis bullosa simplex since childhood. The aspect of the lesions and electron microscopy were in favour of the diagnosis of the Dowling-Meara variant of epidermolysis bullosa simplex. Both women had several fingernails with pincer and trumpet nail deformities. There were no such signs among the other siblings, who had never had epidermolysis.

DISCUSSION

Nail involvement is not rare during the course of superficial epidermolysis bullosa. The trumpet lesions appear to be relatively specific to the present two cases of epidermolysis bullosa simplex. The electron microscopic findings of these two cases were also noteworthy, with whisk-like but not round clumping of the perinuclear tonofilaments.