RESUMEN
BACKGROUND: Anakinra is a recombinant form of the naturally occurring human interleukin-1 receptor antagonist. It is used in the treatment of rheumatoid arthritis. The most frequent side effects are injection site reactions, which seem to have a toxic mechanism. PATIENTS AND METHODS: We report two unusual cases of injection site reactions with anakinra: a woman presented Wells' cellulitis of the thigh and a man developed serious bacterial cellulitis distinguished by deep necrosis at the site of the latest anakinra subcutaneous injection. DISCUSSION: The cases are examples of serious side effects that can occur during treatment with anakinra and underline the need for careful use of this new biological agent.
Asunto(s)
Antirreumáticos/efectos adversos , Celulitis (Flemón)/inducido químicamente , Eosinofilia/inducido químicamente , Proteína Antagonista del Receptor de Interleucina 1/efectos adversos , Corticoesteroides/administración & dosificación , Corticoesteroides/uso terapéutico , Anciano , Biopsia , Celulitis (Flemón)/tratamiento farmacológico , Celulitis (Flemón)/patología , Femenino , Humanos , Inyecciones Intravenosas , Inyecciones Subcutáneas , Proteína Antagonista del Receptor de Interleucina 1/administración & dosificación , Masculino , Persona de Mediana Edad , Penicilina G/administración & dosificación , Penicilina G/uso terapéutico , Piel/patología , Factores de Tiempo , Resultado del Tratamiento , Cicatrización de HeridasRESUMEN
BACKGROUND: Diagnosis of naevus lesions may be complex where they contain little or no pigmentation. Naevus spilus (or naevus on naevus) is, generally, readily identified by the difference in pigmentation between overlying and underlying naevi and healthy skin. Malignant transformation of naevus spilus is rare. We report two cases of melanoma in which surgical procedures revealed underlying melanocyte lesions, diagnosed at histology but undetectable on clinical examination. PATIENTS AND METHODS: Two patients were operated for melanoma in which surgery, at a site remote from the melanoma, suggested incomplete relapse despite the fact that previous clinical examination had indicated healthy skin. A diagnosis was made of melanoma in invisible naevus spilus. DISCUSSION: Diagnosis of melanoma in invisible naevus spilus may be suspected where several naevi are found together in a specific area. The main problem is the therapeutic stance to be adopted since complete excision of the underlying naevi is difficult in practice. Wood's light examination may be helpful.
