Bilateral nevus comedonicus of the eyelids: An unusual cause of ptosis and ectropion.

PURPOSE: Nevus comedonicus is a rare developmental abnormality of the infundibulum of the hair follicle. OBSERVATION: We report here an unusual case of bilateral extensive nevus comedonicus of the eyelids complicated by bilateral ptosis and ectropion of the lower eyelids. Blepharoplasty was performed on both upper eyelids. Histopathological findings on skin biopsy typically show large, grouped, dilated follicular ostia filled with keratin. CONCLUSIONS AND IMPORTANCE: This case is unusual as regards the late-onset (lesions first appeared at age 35) and location of the nevus comedonicus on both eyelids.

[Zika virus infection: A review]. / L'infection à Zika virus : mise au point.

Zika Virus (ZIKV), originally identified in 1947, is a re-emerging Flavivirus transmitted mainly through bites by Aedes mosquitos. Until the recent outbreaks in the Pacific islands and Central and South America, it was known to cause benign disease, in most cases asymptomatic or with mild and nonspecific symptoms (fever, rash, conjunctivitis, arthralgia, etc.). The unprecedented current epidemic has highlighted new modes of transmission (through blood, perinatally and sexually) as well as serious neurological complications such as congenital defects in the fetuses of infected mothers and Guillain-Barre syndrome in adults. This situation, coupled with the threat of worldwide spread, prompted the WHO to declare the ZIKV a public health emergency of international concern in February 2016.

[Well's cellulitis: A case report]. / La cellulite de Wells : à propos d'une observation.

INTRODUCTION: Wells's cellulitis is a rare eosinophilic dermatose characterized by an inflammatory erythematous eruption, often associated with eosinophilia, and suggestive histologic features. The differential diagnosis with other eosinophilic dermatitis is problematic. The treatment is typically based on systemic steroids. CASE REPORT: We report a 63-year-old patient with an extensive pruritic maculo-papular eruption of the limbs and the trunk, forming large indurated and painful erythematous patches. Blood analysis revealed eosinophilia. Histologic examination showed perivascular eosinophilic inflammatory infiltration, also disposed around collagen fibers. The symptoms disappeared with topical corticosteroids. CONCLUSION: The diagnosis of Well's cellulitis is difficult because of the lack of specific sign; it is based on suggestive clinical, biological and histological features. Topical corticosteroids are efficient and well-tolerated, and should be used as first treatment.

[Pyoderma gangrenosum and neutrophilic aortitis preceding the development of rheumatoid arthritis]. / Pyoderma gangrenosum et aortite neutrophilique précédant l'apparition d'une polyarthrite rhumatoïde.

BACKGROUND: We report a case of pyoderma gangrenosum (PG) associated with a complication comprising ascending aortic dissection (neutrophilic aortitis) in a setting of rheumatoid arthritis (RA). PATIENTS AND METHODS: A 79-year-old female patient was hospitalized in late 2009 for vegetating PG. Treatment with general steroids followed by colchicine and topical steroids resulted in complete healing of skin lesions. During hospitalization, the patient presented dissection of the ascending part of the aorta, for which emergency surgery proved effective. Histological examination of the excised tissue revealed diffuse neutrophilic aortitis. Diagnoses of Takayashu's disease and of lupus were ruled out. A chest CT scan showed interstitial lung disease with mild lymphocytosis in the bronchoalveolar fluid, but with no isolated pathogenic organisms. Relapse of skin lesions occurred 3 and 4 years later, associated with the development of RA, and worsening of the interstitial lung disease was noted in a scan carried out it in 2013, following which stabilization was observed in April 2014. There was no recurrence of the PG lesions. CONCLUSION: To our knowledge, no other cases involving association of neutrophilic aortitis with PG and RA has been published to date. The literature describes the emergence of the concept of systemic neutrophilic dermatoses, and this notion is reinforced by the presence of a cutaneous and aortic site of the neutrophilic disease in a single patient.

[Incidence and characteristics of calciphylaxis in Martinique (2006-2012)]. / Incidence et caractéristiques de la calciphylaxie en Martinique (2006-2012).

BACKGROUND: Calciphylaxis is a rare and severe disease with an annual incidence of around 1 % in dialysis patients. The main study aim was to determine its incidence in Martinique, where there is a significant population of patients on dialysis. PATIENTS AND METHODS: All patients diagnosed with calciphylaxis between 2006 and 2012 and living in Martinique were included, retrospectively. Social, demographic, biological, anatomic, pathological, histological and outcome data were analysed. RESULTS: Fifteen patients were included (8 women, 7 men). The incidence of calciphylaxis in this population was about 4.62/1,000,000 inhabitants per year. All patients presented very painful skin ulcerations and necrosis, chiefly on the lower extremities in 53.3 % of cases. All patients were on haemodialysis and two had undergone renal transplantation. Fourteen of the 15 patients were presenting secondary hyperparathyroidism, 12 had hypertension, 9 peripheral arterial disease, 8 obesity and 8 diabetes mellitus. Raised calcium and phosphorus were noted in 8 patients, with hypoalbuminaemia in 9 patients. Treatment with sodium thiosulfate was given for 8 patients, and was beneficial for all after a mean duration of 3.4 months. After 6 months of follow-up, 8 of the 15 patients were cured, 1 showed improvement and 6 had died. CONCLUSION: To our knowledge, this is the first study to examine the incidence of calciphylaxis in the general population. The relatively large number of patients could be accounted for by the high number of comorbidities in end-stage renal disease patients in Martinique, including obesity, diabetes, hypertension and arteritis. Treatment with sodium thiosulfate was beneficial for 8 patients.

[First case of phaeohyphomycosis due to Pleurostoma ootheca in a kidney transplant recipient in Martinique (French West Indies)]. / Premier cas de phaeohyphomycose à Pleurostoma ootheca chez un greffé rénal en Martinique.

Phaeohyphomycosis is a group of superficial and deep infections due to dematiaceous fungi. They are most common in tropical environments, especially in immunocompromised hosts. We describe the first case of phaeohyphomycosis due to Pleurostoma ootheca in a kidney transplant recipient in Martinique (French West Indies). A 59-year-old man with a kidney graft, treated with mycophenolate mofetil, tacrolimus, and prednisone, presented suppurative tumefaction of the left ankle. Cutaneous and osseous phaeohyphomycosis caused by P. ootheca was diagnosed, based on mycological, histological, and radiological testing. The patient's condition improved with posaconazole treatment. P. ootheca is a known environmental fungus. Immunocompromised hosts are more vulnerable to many infections, due to opportunistic pathogens. Bacteriological, histological, and mycological testing is required for accurate diagnosis and appropriate treatment. Treatment is not well defined and usually relies on antifungal agents or surgical resection or both. An important point to consider is that azole antifungal agents may cause major drug-drug interactions with immunosuppressive agents such as tracrolimus.

[Diabetic muscular necrosis: three Afrocaribbean cases]. / Nécrose musculaire du diabétique : trois cas Afro-caribéens.

INTRODUCTION: Diabetic muscular infarction is an exceptional complication of diabetes mellitus. Patients with macro- and microvascular manifestations are mostly concerned. Muscular pain with swelling of the thigh is the main manifestation, sometimes associated with fever. OBSERVATIONS: We report here five cases of diabetic muscular infarction in three Afro-carribean patients with atypical clinical features. The surgical biopsy procedure allowed the diagnosis and ruled out pyomyositis, a more common bacterial disease on tropical condition. CONCLUSION: This report of three cases of this exceptional disease in a small population seems more related to the high prevalence of diabetes mellitus in the French West Indies than to their ethnic origin.

[Ulcerated nodular lesions on extremities of patient undergoing treatment for glioblastoma on French Caribbean island of Martinique]. / Lésions nodulaires et ulcérées des membres chez un Martiniquais traité pour un glioblastome. Phaéohyphomycose à Exophiala spinifera.

Phaeohyphomycosis comprises a disparate group of cutaneous and systemic mycotic infections caused by dematiaceous fungi. The Exophiala genus includes more than 20 species. The purpose of this report is to describe a case of phaeohyphomycosis due to Exophiala spinifera in a patient under treatment for cerebral glioblastoma on the French Caribbean island of Martinique. A 73-year-old man who was undergoing treatment for a cerebral glioblastoma using radiotherapy, chemotherapy and systemic corticosteroids presented with ulcerated nodular lesions on all four extremities for several months. Histological and mycological examinations led to diagnosis of cutaneous phaeohyphomycoseis due to Exophiala spinifera. Treatment using itraconazole was initiated but the patient died from complications of glioblastoma. Phaeohyphomycosis is a rare and cosmopolitan mycosis. Infection due to Exophiala spinifera is uncommon in humans. It usually but not always occurs in immunocompromised hosts. Although cutaneous involvement is usually localized and has a favorable prognosis, disseminated forms may occur and can be life-threatening. Histological and mycological examinations are useful to confirm the diagnosis. Systematic antifungals with or without surgical resection are often effective. To our knowledge, only 15 reported cases of phaeohyphomycosis due to Exophiala spinifera have been reported up to now.