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.

Phialemoniopsis limonesiae sp. nov. causing cutaneous phaeohyphomycosis in an immunosuppressed woman.

Rare or opportunistic fungal infections are mostly described in immunosuppressed patients. We present a case of a cutaneous phaeohyphomycosis that developed on the dorsal foot in an immunosuppressed woman suffering from AIDS, caused by a novel Phialemoniopsis species. It clinically presented as an indurated violaceous plaque, surmounted by nodules exuding a sero-purulent discharge. A filamentous fungus was isolated from pus and cutaneous biopsy. ITS and LSU sequences phylogenetically resolved the fungus as an unknown species of Phialemoniopsis, which is an unresolved family within Sordariomycetes. In this study we describe the new species as Phialemoniopsis limonesiae, which clusters on a single branch clearly separated from its closest phylogenetic neighbours. This new strain showed low MIC to itraconazole, voriconazole and posaconazole.

A new mutation in the SQLE gene of Trichophyton mentagrophytes associated to terbinafine resistance in a couple with disseminated tinea corporis.

Trichophyton is the most common dermatophyte genus responsible for tinea corporis and topical treatment with terbinafine is effective for limited disease but extensive disease required systemic therapy. Failure of terbinafine therapy in patients infected with T. rubrum or T. mentagrophytes is associated with mutations in the gene encoding squalene epoxidase, the terbinafine target. We report two cases of tinea corporis resistant to systemic terbinafine in a 60-year-old man and his wife, a 51 year-old-woman. Both patients had multiple diffuse erythematous annular scaly plaques and T. mentagrophytes was isolated in culture. Systemic treatment with terbinafine in combination with topical terbinafine and then topical ketoconazole failed to improve the disease after 8 weeks. The broth microdilution tests performed to evaluate the antifungal sensitivity of the T. mentagrophytes isolate revealed a high MIC for terbinafine but a low MIC for posaconazole and itraconazole. An A1223T point mutation leading to a Q408L substitution was identified by DNA sequencing the SQLE gene of the isolate. Itraconazole 200mg daily was then introduced but stopped because of elevated liver transaminases in the man. Finally, complete healing was achieved only six months later for both patients and required a 3 and 2-week regimen of itraconazole with topical eberconazole in the man and woman respectively. We believe that a close monitoring and antifungal susceptibility tests should now be done more systematically in dermatophytic infections that do not respond to conventional treatment as terbinafine resistant strains are likely to spread worlwide.

[Differential diagnoses of infection with Mycobacterium ulcerans: case reports from Akonolinga, Cameroon]. / Diagnostics différentiels de l'infection à Mycobacterium ulcerans : cas cliniques d'Akonolinga, Cameroun.

The authors describe the results of a program for the management of Buruli ulcers in Akonolinga (Cameroon). Its principal objective is to improve the diagnosis of dermatologic lesions and thereby to improve the indications for specific antibiotic therapy. This study, conducted in February, 2013, included 271 patients. Differential diagnosis of suspicious lesions was best with diagnostic examinations completed by histologic examination of a punch biopsy sample and advice from expert dermatologists.

[Neuroborreliosis, tick-borne encephalitis and neurosyphilis]. / Neuroborréliose, méningo-encéphalite verno-estivale et neurosyphilis.

Infections affecting frequently the nervous system include Lyme disease, tick-borne encephalitis and syphilis. These three most dreaded neuro-infectious diseases observed in Switzerland are discussed, based on diagnostic criteria, screening testing, and treatments modalities. Neuroborreliosis and neurosyphilis are bacterial infectious diseases treatable by antibiotics, whereas the treatment of tick-borne encephalitis, a viral disease, is only based on preventive vaccination.

[Benefits of routine psychological counselling for patients living with HIV]. / Bénéfices d'un accompagnement psychologique des patients vivant avec le VIH.

Despite improvement of life expectancy of human immunodeficiency virus (HIV) infected people since the implementation of antiretroviral treatment, psychological suffering prevails and needs to be considered as part of the treatment to guarantee its efficiency. Mental disorders and social stigmatization substantially affect patients' quality of life and their adherence to treatment. The article details the benefits of a routine screening for mental disorders within this population, who is often reluctant to consult psychiatric services. The different treatments provided by the Geneva University Hospital (HUG) are introduced. A clinical case report illustrates the relevance of a multidisciplinary care program and the role of the liaison psychiatry in this field.

Long-term HIV infection and antiretroviral therapy are associated with bone microstructure alterations in premenopausal women.

UNLABELLED: We evaluated the influence of long-term HIV infection and its treatment on distal tibia and radius microstructure. Premenopausal eumenorrheic HIV-positive women displayed trabecular and cortical microstructure alterations, which could contribute to increased bone fragility in those patients. INTRODUCTION: Bone fragility is an emerging issue in HIV-infected patients. Dual-energy X-ray absorptiometry (DXA) quantified areal bone mineral density (BMD) predicts fracture risk, but a significant proportion of fracture risk results from microstructural alterations. METHODS: We studied the influence of long-term HIV infection on bone microstructure as evaluated by high-resolution peripheral quantitative computed tomography (HR-pQCT) in 22 HIV-positive (+ve) premenopausal eumenorrheic women and 44 age- and body mass index (BMI)-matched HIV-negative (-ve) controls. All subjects completed questionnaires regarding calcium/protein intakes and physical activity, and underwent DXA and HR-pQCT examinations for BMD and peripheral skeleton microstructure, respectively. A risk factor analysis of tibia trabecular density using linear mixed models was conducted. RESULTS: In HIV+ve women on successful antiretroviral therapy (undetectable HIV-RNA, median CD4 cell count, 626), infection duration was 16.5 ± 3.5 (mean ± SD) years; median BMI was 22 (IQR, 21-26) kg/m². More HIV+ve women were smokers (82 versus 50 %, p = 0.013). Compared to controls, HIV+ve women had lower lumbar spine (spine T-score -0.70 vs -0.03, p = 0.014), but similar proximal femur BMD. At distal tibia, HIV+ve women had a 14.1 % lower trabecular density and a 13.2 % reduction in trabecular number compared to HIV-ve women (p = 0.013 and 0.029, respectively). HR-pQCT differences in distal radius were significant for cortical density (-3.0 %; p = 0.029). CONCLUSIONS: Compared with HIV-ve subjects, premenopausal HIV+ve treated women had trabecular and cortical bone alterations. Adjusted analysis revealed that HIV status was the only determinant of between group tibia trabecular density differences. The latter could contribute to increased bone fragility in HIV+ve patients.

Cutaneous lumbosacral Herpes simplex virus among patients hospitalized for an advanced disease.

BACKGROUND: Cutaneous Herpes simplex virus (HSV) infections are regularly observed in lumbosacral areas, and many are refractory to appropriate initial diagnosis and management. OBJECTIVE: We aimed to evaluate the incidence of lumbosacral HSV among advanced disease patients, to estimate their survival index from HSV onset, and to describe their clinical and virological characteristics. METHODS: A prospective, descriptive study was conducted in a palliative and continuous care centre, collecting patients with suspected cutaneous HSV lesions in the lumbosacral area. RESULTS: From 2008 to 2010, 24 patients were included: 19 had HSV-2 confirmed by at least one laboratory test. Incidence of HSV-2 was 2.67% (1.73-4.33%, 95% CI). No age, gender or survival differences were observed compared to the global population in the centre. Most lesions were detected early as vesicles (14/24) or small ulcers. Sensitivity was good for all diagnostic methods (62.5% for immunofluorescence and 79.2% for culture and/or PCR). Outcome was favourable under classical antiherpetic drugs and topical antiseptic dressing. CONCLUSIONS: Cutaneous lumbosacral HSV remains uncommon in patients hospitalized with advanced diseases. Most of these patients suffer from pressure ulcers or other dermatitis; we advocate increased attention of this diagnosis to avoid skin complications and added pain.

[Lentigo maligna: a special melanoma]. / Lentigo maligna: un mélanome particulier.

Lentigo maligna (LM) and lentigo maligna melanoma (LMM) account for about 10% of all melanomas. They have distinct clinical and histological features as well as specific epidemiology, natural history, evolution, and genetics. Epidemiology of these tumors progressively concerns younger patients. Diagnostic and preparation of surgical removal of LM and LMM can now be optimized by new technologies of imaging, like dermoscopy or in vivo confocal reflectance microscopy. Surgery is the treatment of choice, but alternative options can be considered, especially for the elderly for whom the needs for efficiency and acceptability should be met.

Kaposi's sarcoma after repeated surgical procedures in an immunocompetent patient: the lymphatic hypothesis.

A 63-year-old Swiss patient developed acquired nodules on his right palm after 3 localized surgeries, called 'needle fasciotomy', for Dupuytren's disease. Kaposi's sarcoma (KS) was diagnosed in a biopsy of a nodule. A positive immunolabeling and serology for human herpesvirus 8 has been found, but human immunodeficiency virus and hepatitis C identification remained negative. The nodules were limited to the surgically traumatized area. This first report of a nonimmunocompromised patient developing a KS after repeated surgeries in a unique peculiar localized area with a dense lymphatic network sustains the hypothesis that tissue alterations involving the lymphatic system could play a central role in the occurrence of KS.

Swimming pool deck as environmental reservoir of Fusarium.

While investigations on fungal contamination of swimming pools usually focus on dermatophytes, data on other potentially pathogenic molds are scarce. Here, we report the investigation of fungal colonization of the deck surrounding a hospital physical therapy swimming pool. Five series of samples from 8 sites were collected over one year from the pool surroundings. Concomitantly, 58 patients using the swimming pool were examined and samples obtained from those with suspected onychomycosis. All surface samples were positive for fungi, with Fusarium the most frequently recovered from 22 of 27 samples of sites surrounding the pool. Among the outpatients evaluated, two presented with a mixed onychomycosis from which Fusarium and Trichophyton rubrum were isolated. The questions of possible acquisition from the swimming pool area must be considered in both cases as the ungual lesions had developed within the previous three months. This warrants further studies to better understand the epidemiology of potentially pathogenic molds in areas surrounding pools in order to adopt appropriate measures to avoid contamination. This is of particular importance within medical institutions, considering the potential role of Fusarium onychomycosis as a starting point for disseminated infections in immunocompromised patients.

Assessment of a real-time PCR test to diagnose syphilis from diverse biological samples.

OBJECTIVES: To investigate the contribution of a real-time PCR assay for the detection of Treponema pallidum in various biological specimens with the secondary objective of comparing its value according to HIV status. METHODS: Prospective cohort of incident syphilis cases from three Swiss hospitals (Geneva and Bern University Hospitals, Outpatient Clinic for Dermatology of Triemli, Zurich) diagnosed between January 2006 and September 2008. A case-control study was nested into the cohort. Biological specimens (blood, lesion swab or urine) were taken at diagnosis (as clinical information) and analysed by real-time PCR using the T pallidum 47 kDa gene. RESULTS: 126 specimens were collected from 74 patients with primary (n = 26), secondary (n = 40) and latent (n = 8) syphilis. Among primary syphilis, sensitivity was 80% in lesion swabs, 28% in whole blood, 55% in serum and 29% in urine, whereas among secondary syphilis, it was 20%, 36%, 47% and 44%, respectively. Among secondary syphilis, plasma and cerebrospinal fluid were also tested and provided a sensitivity of 100% and 50%, respectively. The global sensitivity of T pallidum by PCR (irrespective of the compartment tested) was 65% during primary, 53% during secondary and null during latent syphilis. No difference regarding serology or PCR results was observed among HIV-infected patients. Specificity was 100%. CONCLUSIONS: Syphilis PCR provides better sensitivity in lesion swabs from primary syphilis and displays only moderate sensitivity in blood from primary and secondary syphilis. HIV status did not modify the internal validity of PCR for the diagnosis of primary or secondary syphilis.

[10 years of lipodystrophy--and so many uncertainties]. / Dix ans de lipodystrophie (1998-2008): un syndrome encore méconnu.

HIV lipodystrophy is characterized by peripheral, subcutaneous lipoatrophy in the face, arms, legs, and buttocks and central fat accumulation in the neck, breasts, and abdomen (referred as lipohypertrophy). Lipodystrophy is associated with atherogenic lipid abnormalities, low levels of HDL cholesterol, insulin resistance, and, less commonly, hyperglycaemia. Causes of lipodystrophy are not completely elucidated. The prevalence of lipodystrophy ranges from 20% to 70% of the patients after one year of ART, depending on the type of ART, with lower prevalence in more recent studies of newer agents. Treatment strategies are disappointing. A multidisciplinary approach is now proposed in the Geneva University Hospital in order to coordinate efforts from different department, including internal medicine, infectiology or esthetic surgery for example.

Linear Darier disease with herpes zoster superinfection treated successfully by brivudine.

We report the case of a human immunodeficiency virus-positive patient presenting linear Darier disease with varicella-zoster virus superinfection following the lines of Blaschko. The lesions healed after treatment with brivudine.

[Treatment of cutaneous human papilloma virus, poxvirus and herpes simplex virus infections with topical cidofovir in HIV positive patients]. / Traitement par cidofovir topique d'infections cutanées à papillomavirus humain, poxvirus et herpes simplex virus chez des malades séropositifs pour le VIH.

INTRODUCTION: Cidofovir (Vistide) is an antiviral marketed for the treatment of cytomegalovirus retinitis. Clinical efficacy has been reported with its broad antiviral spectrum that includes poxvirus, human papilloma virus and Herpes simplex. In immunodepressed patients, these infectious dermatoses are often recurrent and resistant. In an open study, we assessed the efficacy and clinical tolerance of cidofovir gel at 1 p. 100. PATIENTS AND METHODS: Twelve HIV-infected adults were included. Cidofovir gel at 1 p. 100 was applied directly on the lesions, once a day, for two weeks on the molluscum and condylomas, four weeks on the warts and one week on the chronic herpes. RESULTS: Four patients presented with warts and 3 of them with verruca plana. In 2 of the verruca plana patients, regression was complete although relapse was observed. Two failures were noted. Local application of the gel was not tolerated by one patient suffering from condylomas of the penis. Four patients presented with molluscum contagiosum. Two complete regressions with strong local reaction and two partial regressions were observed. The latter two patients exhibited severe immunodepression, one of them subsequently received infusions of cidofovir. Two women suffering from vulvar and perianal herpes resistant to acyclovir were treated for one week with cidofovir gel at 1 p. 100: no response was obtained. One of the patients stopped treatment because of local intolerance. A third, less immunodepressed, woman responded partially. COMMENTS: In HIV-positive patients, cidofovir in topical form appears to be indicated in extensive and confluent molluscum contagiosum. However, the effect occurs at the cost of local inflammation. The results are disappointing in papillomavirus lesions and in chronic acyclovir-resistant herpes ulcerations, efficacy is debatable.

Three cases of cutaneous sarcoidosis: search for bacterial agent by the 16S RNA gene analysis and treatment with antibiotics.

BACKGROUND: The aetiology of sarcoidosis remains controversial. An infectious origin is often discussed, but only anti-inflammatory or immunosuppressive treatment is recommended. OBJECTIVES: To investigate the hypothesis of bacterial origin by treating cutaneous sarcoidosis with antibiotics. METHODS: Patients with chronic cutaneous sarcoidosis, unresponsive to the usual treatment and not requiring systemic corticotherapy, were given combined antibiotherapy for 6 months. Search for bacterial DNA by amplification and sequencing of the 16S ribosomal RNA gene in skin biopsies of lesions before and after antibiotherapy was done. RESULTS: Three patients received a combined treatment with clarithromycin 1 g/day and ciprofloxacin 1 g/day. No clinical changes occurred in 2 cases and transient worsening in 1. Amplification for bacterial DNA was positive in all skin biopsies. The sequencing of this DNA could not identify a unique bacterial species. CONCLUSION: No evident bacterial origin could be demonstrated; however, this approach should be extended to more patients.