RF36 | PMON301 The Local Androgen-Estrogen Environment Differentially Regulates Adipocyte Lipid Metabolism by Fat Depot and Sex

Obese men often have low blood testosterone (Test) levels yet may have high or low blood 17β-estradiol (E₂) levels while showing an increased risk of type 2 diabetes. In contrast, women with polycystic ovary syndrome (PCOS) experience increased risk of visceral white adipose tissue (vWAT) deposition, insulin resistance, and cardiovascular disease. Overall, insulin resistance is correlated with hypoandrogenemia in males and hyperandrogenemia in females. The aim of the present study was to elucidate the sexually dimorphic role androgens play in regulating the adipocyte insulin signaling pathway. We hypothesized that androgens would upregulate insulin signaling pathway components in female vWAT adipocytes irrespective of E₂ levels. We further hypothesized that androgens would downregulate insulin signaling pathway components in male vWAT adipocytes dependent on E₂ levels. vWAT and subcutaneous white adipose tissue (scWAT) were collected from male and female rats, digested in sterile-filtered collagenase, and the resulting preadipocytes were proliferated to 80% confluence. After cell cultures were induced to a minimum of 60% adipocyte cells, cells were exposed to the following treatments: no steroid, 5a-dihydrotestosterone (DHT), E₂, Test, fulvestrant, Test + letrozole, and Test + fulvestrant for 48 hours. Adipocyte protein was western blotted for Total AKT and p-AKTSer473 and normalized to GAPDH. qPCR was performed to quantify insulin receptor (Insr), insulin receptor substrate 1 (Irs1), protein kinase B isoform 2 (Akt2), fork head box protein 1 (Foxo1) using the housekeeping gene Gapdh. 48-hour steroid treatments of E2 reduced pAKTSer473: AKT compared with that of controls in male vWAT. Interestingly, pAKTSer473: AKT of E₂-treated male scWAT was unchanged compared with control levels. Yet, for both male scWAT and vWAT, Test and fulvestrant treatments had greater pAKTSer473: AKT than in E₂-treated cells, while T + letrozole-treated male scWAT also showed higher pAKTSer473: AKT than in E₂ treatments. In contrast, T + fulvestrant increased pAKTSer473: AKT in female vWAT. Protein data for females and Foxo1 protein are still being generated. At the RNA level female scWAT had upregulated Insr in response to Test + fulvestrant and Akt2 and Foxo1 to Test+ fulvestrant. In both male and female vWAT fulvestrant upregulates the Insr. As we see differences in the Test, fulvestrant and letrozole treatments, the control of local androgens over insulin signaling in WAT may vary by local ERa and ERβ expression and/or steroidogenesis. Furthermore, estrogenic effects on insulin signaling seem to vary by fat depot in males. Thus, sex-specific pharmaceuticals targeting the intersection of androgens, estrogens, and AKT in WAT can be an important tool in the treatment of insulin resistance in obese patients.

Presentation: Monday, June 13, 2022 12:30 p.m. - 12:35 p.m., Monday, June 13, 2022 12:30 p.m. - 2:30 p.m.

Clinicopathological features of cutaneous reactions after mRNA-based COVID-19 vaccines

BACKGROUND

Cutaneous reactions, mostly on injection site after mRNA-based COVID-19 vaccines, have been reported but not with detailed histopathological characterization.

OBJECTIVES

Characterization and classification of these reactions in a clinical and pathological point of view.

METHODS

Monocentric case series of 11 patients with cutaneous manifestations, clinically and histologically characterized after COVID-19 vaccination.

RESULTS

From January to June 2021, we recorded 11 cutaneous reactions to mRNA COVID-19 vaccines from BNT162b2 (n = 8) and mRNA-1273 (n = 3). Generalized reactions showing erythematous rash or purpura were the most common clinical presentation, and drug-reaction-like pattern was the most common histological finding.

CONCLUSIONS

A proper clinicopathological classification will be helpful in the early diagnosis and management of the cutaneous reactions to mRNA COVID-19 vaccines.

Virilizing doses of testosterone decrease circulating insulin levels and differentially regulate insulin signaling in liver and adipose tissue of females

Transgender men undergoing hormone therapy are at risk for insulin resistance. However, how virilizing testosterone therapy affects serum insulin and peripheral insulin sensitivity in transgender men is unknown. This study assessed the effect of acute, virilizing testosterone on serum insulin concentrations and insulin signaling in liver, skeletal muscle, and white adipose tissue (WAT) of female pigs as a translational model for transgender men. Females received three doses of intramuscular testosterone cypionate (TEST females; 50 mg/day/pig) or corn oil (control) spaced 6 days apart starting on the day of estrus (D0). Fasting blood was collected on D0, D3, D5, D11, and D13, and females were euthanized on D13. On D13, TEST females had virilizing concentrations of serum testosterone with normal concentrations of serum estradiol. Virilizing serum testosterone concentrations (D13) were associated with decreased serum insulin and C-peptide concentrations. Blood glucose and serum glycerol concentrations were not altered by testosterone. Virilizing concentrations of testosterone downregulated AR and ESR1 in subcutaneous (sc) WAT and upregulated transcript levels of insulin-signaling pathway components in WAT and liver. At the protein level, virilizing testosterone concentrations were associated with increased PI3K 110α in liver and increased insulin receptor (INSR) and phospho(Ser256)-FOXO1 in visceral (v) WAT but decreased phospho(Ser473)-AKT in vWAT and scWAT. These results suggest that acute exposure to virilizing concentrations of testosterone suppresses circulating insulin levels and results in increased abundance of proteins in the insulin-signaling pathway in liver and altered phosphorylation of key proteins in control of insulin sensitivity in WAT.NEW & NOTEWORTHY Acute virilizing doses of testosterone administered to females suppress circulating insulin levels, upregulate components of the insulin-signaling pathway in liver, and suppress insulin signaling in white adipose tissue. These results suggest that insulin resistance in transgender men may be due to suppression of the insulin-signaling pathway and decreased insulin sensitivity in white adipose tissue.

Linkage between patients' characteristics and prescribed systemic treatments for psoriasis: a semantic connectivity map analysis of the Swiss Dermatology Network for Targeted Therapies registry

BACKGROUND

Several treatment options are currently available for the treatment of psoriasis.

OBJECTIVE

To explore the main associations between patients' characteristics and systemic treatments prescribed for psoriasis in a large group of patients observed in real-life clinical practice.

METHODS

This was a retrospective analysis of baseline data collected within the Swiss Dermatology Network for Targeted Therapies registry in Switzerland between March 2011 and December 2017. Semantic map analysis was used in order to capture the best associations between variables taking into account other covariates in the system.

RESULTS

A total of 549 patients (mean age 46.7 ± 14.7 years) were included in the analysis. Conventional therapies such as retinoids and methotrexate were associated with no previous systemic therapies for psoriasis, a moderate quality of life (QoL) at therapy onset and older age (≥60 years). Fumaric acid derivatives were associated with mild psoriasis (psoriasis area severity index < 10) and long disease duration (≥20 years). On the other side, cyclosporine and psoralen and ultraviolet A/ultraviolet B treatments were linked to a more severe condition, including impaired QoL, hospitalization and inability to work. Regarding biological therapies, both infliximab and adalimumab were connected to the presence of psoriatic arthritis, severe disease condition and other comorbidities, including chronic liver or kidney diseases and tuberculosis. Etanercept, ustekinumab and secukinumab were all connected to a complex history of previous systemic treatments for psoriasis, moderate disease condition, overweight and university education.

CONCLUSIONS

The analysis shows multifaceted associations between patients' characteristics, comorbidities, disease severity and systemic treatments prescribed for psoriasis. In particular, our semantic map indicates that comorbidities play a central role in decision-making of systemic treatments usage for psoriasis. Future studies should further investigate specific connections emerging from our data.

SUN-100 The Local Androgen-Estrogen Environment Differentially Regulates Adipocyte Lipid Metabolism by Fat Depot and Sex

Obesity rates have tripled world-wide in the last 40 years. While estradiol (E2) stimulates lipogenesis and contributes to a gynecoid white adipose tissue (WAT) distribution pattern, the role of testosterone (T) in adipocyte metabolism is less clear. Obese men have low T serum concentrations but have variable E2 serum concentrations and increased risk for type II diabetes mellitus. Conversely, women with high T serum concentrations (polycystic ovary syndrome (PCOS)), are at risk for increased visceral white adipose tissue (VWAT) deposition and insulin resistance irrespective of serum E2 concentrations. Recently, in vivo T administration was shown to increase lipogenesis and decrease lipolysis in WAT of females, but loss of T in males was linked with decreased adipocyte insulin signaling. We hypothesized that local androgens would up-regulate insulin signaling and depress lipolysis in female VWAT adipocytes irrespective of local E2 levels, but would down-regulate insulin signaling and stimulate lipolysis in male VWAT adipocytes dependent on local E2 levels. Sexually mature chow-fed female and male Sprague-Dawley rats were euthanized and inguinal SCWAT and VWAT were collected. WAT from females was collected during proestrus (ie, high E2) based on vaginal cytology. WAT was digested and preadipocytes were plated, grown to confluence, and induced to become adipocytes. Cells were then treated for 48 hours with the following steroid treatments: no steroid, dihydrotestosterone (DHT, 10^-6 M), and estrogen receptor α (ERα) inhibitor, fulvestrant (10^-6 M), with T (10^-6 M). After 48 hours, cells were collected for qPCR (insulin receptor (Insr), insulin receptor substrate 1 (Irs1), protein kinase B 2 (Akt2), forkhead box protein 1 (Foxo1), aromatase A1 (Cyp19A1) and western blotting (phosphorylated AKT (pAKT)/AKT and phosphorylated FOXO1 (pFOXO1)/FOXO1 ratios) and media was collected for T and E2 analysis. Adipocytes collected from female rats cultured in fulvestrant and T (Fulv + T) had increased transcript levels of Insr, Irs1, Akt2 in VWAT and SCWAT. Interestingly, Fulv + T increased protein phosphorylation of AKT and FOXO1 only in VWAT adipocytes from females. In contrast, VWAT adipocytes from males had decreased protein phosphorylation of AKT and FOXO1 in response to Fulv +T but had no response at the transcript level to any androgen treatment. Irrespective of sex, both VWAT and SCWAT adipocytes had decreased glycerol release (i.e., lipolysis) in response to Fulv +T. In a steroid-free environment, the T:E2 ratio was highest for male VWAT and lowest for female SCWAT, indicating that male VWAT had the lowest and female SCWAT had the highest aromatase function. However, Cyp19A1 transcript levels were decreased in DHT and increased in Fulv +T of female VWAT. These sexually dimorphic findings suggest that local androgen control of basal lipogenesis and lipolysis is mediated by E2 and adipose location.

Swiss S1 guideline for the treatment of rosacea

Rosacea (in German sometimes called 'Kupferfinne', in French 'Couperose' and in Italian 'Copparosa') is a chronic and frequently relapsing inflammatory skin disease primarily affecting the central areas of the face. Its geographic prevalence varies from 1% to 22%. The differential diagnosis is wide, and the treatment is sometimes difficult and varies by stage of rosacea. For erythematous lesions and telangiectasia, intense pulsed light (IPL) therapy and lasers are popular treatment option. In addition, a vasoconstrictor agent, brimonidine, has recently been developed. For papulopustular rosacea, topical antibiotics, topical and systemic retinoids, as well as systemic antibiotics are used. A topical acaricidal agent, ivermectin, has undergone clinical development and is now on the market. In the later stages, hyperplasia of the sebaceous glands develops, resulting in phymatous growths such as the frequently observed bulbous nose or rhinophyma. Ablative laser treatments have largely replaced classical abrasive tools. Here, we reviewed the current evidence on the treatment of rosacea, provide a guideline (S1 level) and discuss the differential diagnosis of rosacea.

[Atypical scurvy associated with anorexia nervosa]

INTRODUCTION

Scurvy, or "Barlow's disease", is a widely described disease involving cutaneous and mucosal lesions resulting from vitamin C deficiency. Herein, we report a case of scurvy in a 48-year-old woman that was unusual in its atypical cutaneous-mucosal presentation as well as its association with anorexia nervosa.

PATIENTS AND METHODS

A 48-year-old woman treated for depression for several years was admitted to hospital for her impaired general state of health. Over the last year, she had presented palmoplantar rash and episodes of perimalleolar oedema. The clinical examination showed the patient to have wasting syndrome, with a BMI of 11.9kg/m², lower-limb oedema, palmoplantar fissures, geographic tongue, telogen effluvium and purpuric petechiae on her right knee. However, no gingival bleeding was noted and there was no loss of tooth enamel. The remainder of the clinical examination was normal. Blood tests revealed extremely low vitamin C levels without any other associated deficiencies, as well as laboratory signs of cytolysis and anicteric cholestasis without inflammatory syndrome. The diagnosis of anorexia nervosa was made by psychiatrists, despite the unusual age of onset. Favorable clinical outcome was rapidly achieved via a one-month course of vitamin C supplements at a daily dose of 1g.

DISCUSSION

The absence of classical buccal-dental symptoms and the presence of keratotic dermatosis with fissures and ulcers on the hands and feet are atypical in scurvy; however, this diagnosis was confirmed by the existence of purpura evoking capillary fragility, the patient's drastically low vitamin C level and the rapid subsidence of symptoms following treatment with oral vitamin C alone. Anorexia nervosa was doubtless the cause of deficiency. This situation is rare and a systematic review of the literature in Medline via PubMed showed that only three reports of scurvy associated with mental anorexia have been published since 1975.

[What's new in internal medicine?]

This article focuses on current trends in various autoimmune diseases of interest for the dermatologist. In the antiphospholipid syndrome, many news: better characterization of the severe disease, involvement of the mTOR pathway in the vasculopathy-induced renal disease, and diversification of the therapeutic approaches: use of mTOR inhibitors and several biologics, new various antiplatelet and anticoagulants. In dermatomyositis, new autoantibodies are better characterized with a good correlation with clinical disease; the results of a large study on genetic predisposition to the disease are available. There are also some therapeutic innovations in systemic sclerosis: benefit of rituximab that seems well tolerated, the results of a large controlled European study about aggressive immunoablative chemotherapy followed by autologous stem cells have just been published, intralesional stem cells injections in the fingers of sclerodactylic patients. Finally, news in celiac disease that is constantly increasing and whose mild forms often have cutaneous manifestations, leading to diagnosis.

Pruritic acquired nevus of Ota

Nevus of Ota is a unilateral, asymptomatic cutaneous and mucosal hyperpigmentation of the face that is congenital or may appear during childhood. We present a case of symptomatic acquired nevus of Ota in an adult, associated with intense pruritus, not described in the literature so far. A 32-year-old woman presented with brownish mottled macules which appeared on her face progressively over 8 days, following the distribution of the first and second divisions of the left trigeminal nerve and partially covering the iris and sclera of the left eye. She reported an intense pruritus in this area. We performed a biopsy on the left forehead, which confirmed the diagnosis of nevus of Ota. Specific stains and immunohistochemistry revealed increased numbers of mast cells. Ophthalmological tests showed acute acquired melanocytosis of the left iris and sclera. The origin of the nevus is still unclear. Several hypotheses suggest a reactivation of melanocytes during their migration from the neural crest. The pruritus reported in our patient may be explained by the increased quantity of mast cells observed in the lesion and/or neuronal stimulation of the ophthalmic and maxillary divisions of the fifth cranial nerve.

Primary cutaneous posttransplant lymphoproliferative disorders in solid organ transplant recipients: a multicenter European case series

Primary cutaneous posttransplant lymphoproliferative disorders (PTLD) are rare. This retrospective, multicenter study of 35 cases aimed to better describe this entity. Cases were (re)-classified according to the WHO-EORTC or the WHO 2008 classifications of lymphomas. Median interval between first transplantation and diagnosis was 85 months. Fifty-seven percent of patients had a kidney transplant. Twenty-four cases (68.6%) were classified as primary cutaneous T cell lymphoma (CTCL) and 11 (31.4%) as primary cutaneous B cell PTLD. Mycosis fungoides (MF) was the most common (50%) CTCL subtype. Ten (90.9%) cutaneous B cell PTLD cases were classified as EBV-associated B cell lymphoproliferations (including one plasmablastic lymphoma and one lymphomatoid granulomatosis) and one as diffuse large B cell lymphoma, other, that was EBV-negative. Sixteen (45.7%) patients died after a median follow-up of 19.5 months (11 [68.8%] with CTCL [6 of whom had CD30(+) lymphoproliferative disorders (LPD)] and 5 [31.2%] with cutaneous B cell PTLD. Median survival times for all patients, CTCL and cutaneous B cell PTLD subgroups were 93, 93, and 112 months, respectively. Survival rates for MF were higher than those for CD30(+) LPD. The spectrum of primary CTCL in organ transplant recipients (OTR) is similar to that in the general population. The prognosis of posttransplant primary cutaneous CD30(+) LPD is worse than posttransplant MF and than its counterpart in the immunocompetent population. EBV-associated cutaneous B cell LPD predominates in OTR.

Intralesional infliximab in noninfectious cutaneous granulomas: three cases of necrobiosis lipoidica

BACKGROUND

Necrobiosis lipoidica is a rare granulomatous noninfectious skin disease. Treatment of this chronic debilitating disease is of importance because ulceration of the plaques may induce important psychological and physical morbidity.

OBJECTIVE

Infliximab, an anti-TNF-α chimeric monoclonal antibody used intravenously and intralesionally for other extradermatological granulomatous diseases including Crohn's disease and sarcoidosis, was administered by intradermal injection in necrobiosis lipoidica. The aim of this study was to evaluate the efficacy and safety profile of a locally delivered drug compared to its systemic use.

PATIENTS AND METHODS

Weekly injections of intralesional infliximab for 3 weeks were followed by a 1-week treatment interruption. This treatment schedule was repeated thrice.

RESULTS

Two patients who benefitted from complete treatment experienced almost complete remission for up to 18 months. The third patient, who had treatment interruptions, showed partial improvement. No serious side effects were noticed, although the injections caused pain.

CONCLUSIONS

This is the first report about the efficacy and safety of a therapy consisting of intralesional injections of infliximab for a granulomatous skin disease. Although this approach was clearly effective for necrobiosis lipoidica, the disease recurred several months after treatment interruption, raising the question of the need for maintenance therapy. Further controlled long-term trials are thus necessary.

[Seborrhoeic dermatitis: clinical manifestations and management]

Seborrhoeic dermatitis is a frequent chronic inflammatory dermatosis characterized by erythematous patches surmounted by fatty and yellowish scales, affecting particularly the scalp, the naso-labial folds and the eyebrows. Its etio-pathogeny is still not clear, but Malassezia type yeast appear to play a very important role in its development. Several conditions can be associated with high prevalency of seborrhoeic dermatitis (HIV, Parkinson's disease, Down's Syndrome). No curative treatment is available yet, but nevertheless the symptomatology can be controlled, mainly with topical treatments, and particularly antifungals. This article will develop first clinical and pathological aspects of the disease, then propose therapeutic recommendations based on evidences from the literature.

Soft wheat instead of hard wheat in pelleted diets results in high starch digestibility in broiler chickens

(1) The aim of the experiment was to re-examine variations in digestibilities of food components in 3-week-old broiler chickens fed on pelleted diets based on wheats differing in lipase activity and hardness. Fourteen wheat (Triticum aestivum) samples, each from a different cultivar, were included at 550 g/kg in 14 different diets given to male Ross broiler chicks from 7 d of age. The other main ingredients consisted of soyabean meal (353 g/kg) and rapeseed oil (55 g/kg). A 15th diet containing durum wheat (Triticum durum) was also tested. (2) Hardness of wheats (Triticum aestivum) varied between 14 (very soft) and 88 (very hard), and lipase activity of wheats varied from 1 to 13.1 (relative scale). No significant correlation was found between in vitro viscosities and other parameters such as hardness, particle size of wheat flours and lipase. Hardness was correlated with the mean particle size of wheat flours and durability of pellets. (3) Individual lipid digestibilities were negatively correlated with in vitro viscosities of wheats. (4) Individual starch digestibilities were negatively correlated with wheat hardness, particle size of wheat flour before pelleting, and pellet durability. The ratio of measured AME(N) to predicted AME(N) was also negatively correlated with wheat hardness. Simple regression calculation showed that a 100-point increase in wheat hardness resulted in a 3% decrease in the AME(N) value of diets. Multiple regression calculation showed the food/gain ratio (d 10 to d 21) to be positively related to wheat hardness and negatively related to pellet durability. (5) Wheat lipase activity was positively correlated with individual starch digestibility, which was the reverse of a result obtained in a previous experiment. Thus, wheat lipase activity did not seem consistent for predicting starch digestibility and AME(N) values. (6) Among all wheat samples, durum wheat showed the highest protein content and the lowest content of water-insoluble cell-wall. Starch digestibility of durum wheat tended to be lower than that of other wheats (0.916 vs 0.936). However, no significant difference in AME(N) was observed between the durum wheat sample and other wheats. (7) Gut morphometric data measured at d 24 did not show significant differences between dietary treatments.

[Swiss clinical practice guidelines for skin cancer in organ transplant recipients]

Swiss clinical practice guidelines for skin cancer in organ transplant recipients Transplant patients have increased over the last decades. As a consequence of long-term immunosuppression, skin cancer, in particular squamous cell carcinoma (SCC), has become an important problem. Screening and education of potential organ transplant recipients (OTRs) regarding prevention of sun damage and early recognition of skin cancer are important before transplantation. Once transplanted, OTRs should be seen yearly by a dermatologist to ensure compliance with sun avoidance as well as for treatment of precancerosis and SCC. Early removal is the best treatment for SCC. Reduction of immunosuppression, switch to mTOR inhibitors and chemoprevention with acitretin may reduce the incidence of SCC. The dermatological follow-up of OTRs should be integrated into a comprehensive post-transplant management strategy.

Swiss clinical practice guidelines for skin cancer in organ transplant recipients

Patients with a solid organ transplant have increased in numbers and in individual survival in Switzerland over the last decades. As a consequence of long-term immunosuppression, skin cancer in solid organ recipients (SOTRs) has been recognized as an important problem. Screening and education of potential SOTRs about prevention of sun damage and early recognition of skin cancer are important before transplantation. Once transplanted, SOTRs should be seen by a dermatologist yearly for repeat education as well as early diagnosis, prevention and treatment of skin cancer. Squamous cell carcinoma of the skin (SCC) is the most frequent cancer in the setting of long-term immunosuppression. Sun protection by behaviour, clothing and daily sun screen application is the most effective prevention. Cumulative sun damage results in field cancerisation with numerous in-situ SCC such as actinic keratosis and Bowen's disease which should be treated proactively. Invasive SCC is cured by complete surgical excision. Early removal is the best precaution against potential metastases of SCC. Reduction of immunosuppression and switch to mTOR inhibitors and potentially, mycophenolate, may reduce the incidence of further SCC. Chemoprevention with the retinoid acitretin reduces the recurrence rate of SCC. The dermatological follow-up of SOTRs should be integrated into the comprehensive post-transplant care.

[Borrelial erythema of the face]

BACKGROUND

Borrelial infection is characterized by various skin manifestations that are usually classified into three main types: chronic migratory erythema, borrelial lymphocytoma and acrodermatitis chronica atrophicans. We report an unusual case of borrelial cutaneous infection presenting as a mediofacial erythema that cannot be included in any of these three categories.

CASE REPORT

A 51-year-old woman presented with infiltrated erythema of the middle of the face extending to the neck and chin. Medical history and physical examination revealed no signs of rosaceae. Infection with Borrelia was suspected on skin biopsy examination, which showed an inflammatory dermal infiltrate containing numerous plasma cells. The diagnosis of B.afzelii infection was confirmed by serology and polymerase chain reaction on the skin biopsy, both of which were positive for B.afzelii.

DISCUSSION

Borrelial erythema of the face may represent a special form of cutaneous borrelial infection, which must be considered in the differential diagnosis of facial erythema, especially in areas of endemic borreliosis.

[Pediatric psoriasis]

Psoriasis is a cutaneous inflammatory disorder that may be seen in childhood, sometimes complicated by serious forms. The diagnosis is often more difficult than in adults, because initial lesions may be atypical or pauci-symptomatic. Psoriasis is a chronic disease, with a prognosis worse than atopic dermatitis; patients and their family generally need long term therapy and supportive care. The treatment is not different from that of the adult, but is less studied and less validated by specific pediatric controlled studies.

Bilateral giant retinal tear and retinal detachment in a young emmetropic man after Jarish-Herxheimer reaction in ocular syphilis

BACKGROUND

Giant retinal tears were previously described in patients affected by panuveitis. We report the case of a patient presenting giant retinal tears in both eyes affected by ocular syphilis.

PATIENT AND METHOD

A 45-year-old patient presented a 5 days history of sudden bilateral drop of vision, two weeks after penicillin therapy for secondary syphilis. The best visual acuity was 0.5 RE and light perception LE. Biomicroscopy showed an intense vitritis associated with bilateral giant tear and retinal detachment. Both TPHA and VDRL were positive. Lumbar puncture showed lymphoplasmocytosis with intrathecal synthesis of IgM.

RESULTS

Topical steroids treatment was applied and intravenous penicillin was given during 14 days. Pars plana vitrectomy with silicon oil tamponade was performed in association with endophotocoagulation in the left eye and cryocoagulation in the right eye. Vitreous PCR was negative. Evolution was successful with an attached retina.

CONCLUSIONS

This represents the first reported case of giant retinal tear with retinal detachment in a patient presenting a syphilitic panuveitis.

Sirolimus-Induced Acneiform Eruption

Sirolimus is a new immunosuppressive agent used to prevent rejection in renal allograft recipients in order to reduce the need of potentially nephrotoxic calcineurin inhibitors (cyclosporine, tacrolimus). The cutaneous side effects of sirolimus are not well known and they may have been underestimated. We report 2 cases of follicular acneiform eruptions induced by sirolimus in renal allograft recipients. This dermatologic complication was severe and difficult to treat, and resolved only after discontinuation of sirolimus.

Severe Pustular Eruption Associated with Imatinib and Voriconazole in a Patient with Chronic Myeloid Leukemia

Imatinib is a specific and potent inhibitor of the BCR-ABL tyrosine kinase. Several clinical trials have demonstrated the efficacy of imatinib in chronic myeloid leukemia. Adverse cutaneous reactions induced by imatinib are frequent and may be dose related. We report a case of an unusual pustular eruption in a patient with chronic myeloid leukemia, who received high doses imatinib for blast crisis and later voriconazole for invasive pulmonary aspergillosis. At the time of his skin eruption, elevated plasma levels of imatinib were recorded. Imatinib is primarily metabolized by the cytochrome CYP3A4. Voriconazole is a cytochrome CYP3A4 inhibitor and can lead to high plasma levels of imatinib. This case suggests that severe drug reactions to imatinib may be related not only to imatinib doses, but also to elevated plasma drug levels resulting from pharmacokinetic interactions. The monitoring of imatinib plasma levels may be of help for identifying patients at risk for severe toxicity.

Bullous pemphigoid antigen 1 isoforms: potential new target autoantigens in multiple sclerosis?

BACKGROUND

The simultaneous occurrence of bullous pemphigoid (BP) and multiple sclerosis (MS), two autoimmune diseases involving the skin and the central nervous system (CNS), respectively, has been described.

OBJECTIVES

As the BPAG1 gene encodes the epithelial isoform of BP antigen 1 (BPAG1-e), a major autoantigen of BP, as well as additional variants expressed in the neurones of the CNS and peripheral nervous system and in Schwann cells, we tested the hypothesis that products of the BPAG1 gene act as shared autoantigens in both BP and MS.

METHODS

The reactivity of cerebrospinal fluid (CSF) obtained from 18 patients with MS, 10 patients with other inflammatory CNS diseases and 20 normal controls was assayed by immunoblotting against two recombinant fragments of BPAG1-e encompassing regions that are also found in the neuronal variants BPAG1-n and BPAG1-a.

RESULTS

The recombinant protein glutathione-S-transferase (GST)-BPAG1-e1-887 was recognized by five of 18 (27%) CSF samples obtained from patients with MS, two of 10 (20%) samples from patients with other inflammatory neurological diseases and five of 20 (25%) samples from normal controls. Furthermore, two of 18 (11%) CSF samples from patients with MS bound to GST-BPAG1-e1880-2649, whereas none of the samples obtained from patients with other inflammatory neurological diseases or from control subjects showed reactivity.

CONCLUSIONS

These results raise the possibility that a subset of patients with MS develops an autoantibody response to the neuronal variants of BPAG1. These findings potentially open the avenue of neuronal BPAG1 variants being novel targets of autoantibodies in neurological diseases.

[Treatment of atopic dermatitis: practical approach]

Atopic dermatitis (AD) is a chronic disease frequent in childhood. The treatment is based on regular moisturizing of the skin, information to the parents on the chronic course with recurrent flares, topical anti-infectious therapy for superinfections and colonization of the skin by staphylococcus aureus, and topical steroids. The immuno-modulatory macrolides (tacrolimus and pimecrolimus) represent a new alternative to topical steroids. These molecules are well tolerated, but theirs effects on the long-term are unknown. A food allergy may be responsible for a AD flare in up to a third of the cases, but the presence of an allergy should be demonstrated before the prescription of an elimination diet. AD is often the first manifestation of atopy: the physician should be aware of the future occurence of respiratory symptoms.

[Pseudomonas eccrine hidradenitis in a child revealing acute lymphoblastic leukemia]

INTRODUCTION

We report the case of a Pseudomonas (P.) aeruginosa eccrine hidradenitis in a child, or a "Pseudomonas Hot Foot Syndrome", revealing an acute lymphoblastic leukemia.

OBSERVATION

A 10 year-old girl consulted for the sudden onset of painful and necrotic palmoplantar nodules in a context of fever and shivering. Histology of a cutaneous biopsy found necrosis of the eccrine glands and, on culture, P. aeruginosa. The blood count revealed pancytopenia and the myelogram acute lymphoblastic leukemia. All the hemocultures and other microbiological samples were negative. The cutaneous signs had appeared 48 hours after bathing in an aquatic amusement park. Diagnosis of Pseudomonas eccrine hidradenitis, or "Pseudomonas Hot Foot Syndrome" was retained, although the local sanitary authorities were not able to demonstrate P. aeruginosa contamination of the water in the park.

COMMENTS

Lesions evoking juvenile Pseudomonas aeruginosa eccrine hidradenitis without obvious traumatic factor must lead to the search for P. aeruginosa contamination from water and the subsequent sanitary and epidemiological consequences. Furthermore, severe P. aeruginosa cutaneous infections in children must also lead to the search for an underlying immunosuppression and notably an acute leukemic process.