Aetiologies of creeping eruption: 78 cases.

BACKGROUND: Creeping eruption is a migratory linear cutaneous trail. In addition to hookworm-related cutaneous larva migrans (HrCLM), other diseases can also be revealed by this sign. OBJECTIVES: To report the different aetiologies of creeping eruption. METHODS: All consecutive patients with creeping eruption presenting to our unit in Pitié Salpêtrière Hospital in Paris between 1 March 2008 and 31 January 2013 were included. The diagnoses were based on microscopic data when available (hookworm folliculitis, strongyloidiasis) or the association of epidemiological, clinical, biological features and good outcome after specific treatment (HrCLM, loiasis, gnathostomiasis). RESULTS: Seventy-four patients (95%) presented with HrCLM. All but one had been travelling in a tropical country; seven (9%) also presented with folliculitis. Skin scraping of hookworm folliculitis lesions was performed in five cases and revealed living nematode larvae in three cases. Two patients (3%) with cutaneous gnathostomiasis after returning from Bali and Japan presented with intermittent creeping dermatitis on the foot and thigh, respectively. One patient (1%), native to Cameroon, was diagnosed with loiasis and one patient (1%), with no travel history, presented with 'creeping hair'. CONCLUSION: Hookworm-related cutaneous larva migrans explains 95% of the cases of creeping eruption; gnathostomiasis, loiasis and cutaneous pili migrans may also be diagnosed.

The efficacy of single dose ivermectin in the treatment of hookworm related cutaneous larva migrans varies depending on the clinical presentation.

BACKGROUND: Treatment of hookworm-related cutaneous larva migrans (HrCLM) with a single dose of oral ivermectin has not been adequately evaluated to date. Response rates reported in three large studies varied from 77% to more than 95%. OBJECTIVES: We evaluated the efficacy of ivermectin in the treatment of HrCLM. METHODS: We retrospectively studied all returning travellers with HrCLM who consulted in our institution. Patients were then treated with a single, 200 µg/kg dose of ivermectin, orally. RESULTS: Sixty-two travellers (35 female, 27 male, mean age 35.6 years) with HrCLM and creeping dermatitis were included. Six patients (10%) also had associated hookworm folliculitis. Fifty-nine patients (95%) completely responded with one ivermectin dose. The response rate was 98% in the 56 patients presenting with only creeping dermatitis and 66% in the six patients presenting with additional hookworm folliculitis (P = 0.02). CONCLUSION: The efficacy of a single dose of oral ivermectin is higher in patients with only creeping dermatitis than in those with associated hookworm folliculitis.

[Subacute cutaneous lupus erythematosus and cancer: two cases and literature review]. / Lupus cutané subaigu et cancer: deux cas et revue de la littérature.

BACKGROUND: Subacute cutaneous lupus erythematosus is an uncommon dermatosis characterised by a non-scarring, annular photo-distributed dermatosis associated with anti-Ro/SSA antibodies. It is remarkable as a paraneoplastic syndrome (12 cases in the literature). We report two cases of subacute cutaneous lupus erythematosus occurring in patients treated for metastatic breast adenocarcinoma. CASE REPORTS: Case 1: a 72-year-old woman with breast carcinoma relapsing after surgery, chemotherapy, hormone therapy, and without treatment for 6 months, was admitted for an acute erythematous slightly squamous and photo-distributed eruption. On clinical examination, she was found to be presenting polyadenopathy and pleural effusion. Case 2: a 46-year-old woman with a history of breast carcinoma was admitted for an erythematopapular, annular and photo-distributed eruption occurring after a second breast cancer relapse and five months after initiation of docetaxel. A new line of chemotherapy initially resulted in regression of the lesions, and progression of the breast cancer was associated with cutaneous relapse. DISCUSSION: The diagnosis of subacute cutaneous lupus erythematosus was supported in our two patients by the presence of an annular photo-distributed eruption associated with positive testing for anti-Ro/SSA antibodies. Occurrence of the eruption in both cases with relapse of the neoplasia and its improvement after oncological treatment reinforced the diagnosis of paraneoplastic syndrome in one case, and the use of chemotherapy known to trigger lupus could have suggested a diagnosis of drug-induced subacute cutaneous lupus erythematosus. Thus, the association between lupus and cancer is relevant.

Frequency, clinical features and prognosis of cutaneous manifestations in adult patients with reactive haemophagocytic syndrome.

BACKGROUND: Cutaneous involvement has been reported in 30-40% of children with the familial form of haemophagocytic syndrome. However, few studies have focused on cutaneous manifestations in patients with reactive haemophagocytic syndrome (RHS). OBJECTIVES: To describe the frequency, clinical features and prognosis of skin involvement in adult patients with RHS. METHODS: We conducted a retrospective study in a French university-based tertiary centre. The medical records of all adult patients with a suspected or confirmed diagnosis of RHS during a 2-year period were reviewed. Demographic, clinical, biological and histological data of patients were compared using nonparametric tests. RESULTS: The medical charts of 151 patients were reviewed, 69 of whom had a definite diagnosis of RHS (35% women; mean +/- SD age 49 +/- 17 years). The aetiology of RHS was mainly B-cell or T-cell lymphoma (n = 33) or herpesvirus infection (n = 19). Cutaneous manifestations were observed in 32 (46%) patients and were of three types: (i) specific to the underlying malignancy (Kaposi sarcoma n = 8, cutaneous lymphoma n = 4), (ii) reflecting the biological consequences of RHS (thrombopenic purpura n = 10, conjunctival jaundice n = 7), and (iii) a generalized, transient, nonpruriginous maculopapular rash (n = 18). None presented with erythroderma, or with eczematiform, ichthyosiform, psoriasiform or bullous lesions. One patient had cytophagic histiocytic panniculitis. Histological features of maculopapular rash biopsies were usually nonspecific. The rate of in-hospital death was not significantly associated with cutaneous involvement. CONCLUSIONS: A generalized, nonpruriginous, transient, maculopapular rash is frequently observed in patients with RHS. Although nonspecific, awareness of this cutaneous involvement may assist physicians in the initial diagnosis of RHS.

Cutaneous miliary resistant tuberculosis in a patient infected with human immunodeficiency virus: case report and literature review.

We report the case of a patient infected with human immunodeficiency virus who presented with fever and a disseminated papulous eruption, diagnosed as cutaneous miliary tuberculosis. The diagnosis was made by histological examination of a skin biopsy, which showed numerous acid-fast bacilli. A culture grown from a skin biopsy isolated a resistant Mycobacterium tuberculosis strain. The papules disappeared within a few days after starting treatment with pyrazinamide, isoniazid and moxifloxacin.

Xeroderma pigmentosum group C in a French Caucasian patient with multiple melanoma and unusual long-term survival.

We report the case of an 83-year-old French woman with multiple melanomas showing a severe DNA repair deficiency, corrected after transfection by XPC cDNA. Two biallelic mutations in the XPC gene are reported: an inactivating frameshift mutation in exon 15 (c.2544delG, p.W848X) and a missense mutation in exon 11 (c.2108 C>T, P703L). We demonstrate that these new mutations are involved in the DNA repair deficiency and confirm the diagnosis of xeroderma pigmentosum from complementation group C (XP-C). We speculate that the coexistence of a MC1R variant may be involved in the phenotype of multiple melanomas and that the unusual long-term survival may be related to a lower ultraviolet radiation exposure and to a regular clinical follow-up. This patient appears to be the first French Caucasian XP-C case and one of the oldest living patients with XP reported worldwide.

[Treatment of cutaneous infections due to Mycobacterium fortuitum: two cases]. / Traitement des infections cutanées àMycobacterium fortuitum : deux cas.

INTRODUCTION: Cutaneous infections due to Mycobacterium fortuitum, a rapidly growing environmental mycobacteria, are often iatrogenic, resulting from surgery or injection. We report two cases following plastic surgery and describe the outcome after surgery and antibiotics. CASE REPORTS: Two immunocompetent women underwent abdominal plastic surgery and liposuction, which were complicated with recurrent abscesses one and 13 months later respectively. Cultures of bacteriologic samples isolated M. fortuitum in the two patients. The two strains exhibited different antibiotic sensibility profiles. The initial antibiotic therapy consisted of combined amikacin and moxifloxacin in both patients plus imipenem in one, followed by oral doxycycline and clarithromycin in one and moxifloxacin in the other for a total duration of nine and five months, respectively. In both cases, surgical treatment was also given before, during and after antibiotic therapy. No new lesions had appeared six months after the end of antibiotic therapy. DISCUSSION: Cutaneous infections due to M. fortuitum are rare and secondary to iatrogenic skin wounds. The clinical appearance is not specific, accounting for delayed diagnosis. Treatment is difficult and there is no consensus. According to our experience, surgical treatment is essential whereas the efficacy of antibiotics, even involving multiple agents, seems more doubtful.

[Extensive oral condylomas treated by in situ cidofovir injection in an HIV patient]. / Traitement d'une condylomatose orale extensive par cidofovir intralésionnel chez un malade infecté par le VIH.

BACKGROUND: Human papillomavirus infections are difficult to treat and have a high rate of recurrence, especially in a setting of human immunodeficiency (HIV) infection. Moreover, there is no standard treatment for oral condylomas. PATIENTS AND METHODS: We report the partial success of in situ injections of cidofovir in an HIV patient, presenting extensive oral condylomas. The injections were well tolerated and the response was still present at one year while the immune status of the patient was unchanged. DISCUSSION: The efficacy of topical cidofovir against condyloma acuminata has been reported and the value of in situ cidofovir injections for the treatment of laryngeal papillomatosis is well established. This case report shows the need for further investigation of in situ cidofovir injections as an alternative treatment for human papillomavirus lesions that are difficult to treat because of both site and extension.

Treatment patterns of ranibizumab intravitreal injection and dexamethasone intravitreal implant for retinal vein occlusion in the USA.

PurposeRanibizumab, an anti-vascular endothelial growth factor, and dexamethasone, a corticosteroid, have been shown to be effective in treating macular oedema secondary to retinal vein occlusion (RVO) (central RVO (CRVO) and branch RVO (BRVO)). Their real-world usage, however, has yet to be compared. We therefore evaluated ophthalmology visits for both drugs using US patient-level data.MethodsThe IMS Health Real-World Data Medical Claims database was used to identify treatment-naive patients receiving ranibizumab intravitreal injections or dexamethasone intravitreal implants between June 2010 and February 2014 who had 12 months of follow-up data. The primary outcome measure was the mean number of all ophthalmology visits for the two drugs in patients with CRVO and BRVO. Secondary outcome measures included a comparison of treatment visits, non-treatment visits, and time intervals between visits.ResultsOverall, 2822 patients received ranibizumab injections (CRVO, 1178; BRVO, 1644) and 365 received dexamethasone implants (CRVO, 191; BRVO, 174). The mean number (SD) of all ophthalmology visits was higher for patients receiving ranibizumab injections than for those receiving dexamethasone implants (CRVO: 7.2 (3.6) vs 6.2 (3.1), P<0.001; BRVO: 7.1 (3.4) vs 6.3 (3.1), P=0.016).ConclusionsPatients with RVO receiving ranibizumab injections had a mean of approximately one more visit to their ophthalmologist in the first 12 months of treatment than those treated with dexamethasone implants. The visit burden is therefore not substantially different and physicians should focus on the clinical benefits of these drugs when evaluating treatment options for RVO.

Patterns of ranibizumab and aflibercept treatment of central retinal vein occlusion in routine clinical practice in the USA.

BACKGROUND: The intravitreal anti-vascular endothelial growth factor treatments ranibizumab and aflibercept have proven efficacy in clinical trials, but their real world usage in central retinal vein occlusion (CRVO) has not been assessed. We therefore evaluated the treatment patterns of both drugs in a US claims database. METHODS: The IMS Integrated Data Warehouse was used to identify the patients with CRVO in the USA with claims for ranibizumab or aflibercept between 24 September 2012 and 31 March 2014 with at least 12 months follow-up. Patients were required to have had no anti-VEGF treatment code for 6 months before index ('treatment-naive'). Mean numbers of injections and non-injection visits to a treating physician were compared with patients receiving these treatments. RESULTS: Patient characteristics were similar for patients receiving ranibizumab (n=206) or aflibercept (n=79) at index. The mean (±SD) numbers of injections received by patients treated with ranibizumab or aflibercept were 4.4±2.8 and 4.7±2.9 (P=0.38), respectively; the total number of patient visits to their treating physician was 7.3±3.7 and 7.0±2.9 (P=0.52), respectively. For patients receiving one or more injections (n=238), the mean interval between injections was 55.1 days (ranibizumab) and 54.2 days (aflibercept; P=0.44). CONCLUSIONS: Our results suggest that, in routine clinical practice, patients receive a comparable number of injections in the first year of treatment with ranibizumab or aflibercept. This may have implications for commissioning and service development of CRVO care pathways.

Lipid composition of sciatic nerve from dysmyelinating trembler mouse.

The amounts and the distribution of the various lipids were studied in the sciatic nerves from normal and trembler mice. When compared to the normal, the total lipidic amount was reduced by 66% in the trembler mouse, and each class of lipid was decreased nearly the same way, except for the cholesterol esters the value of which increased five times. The level of each individual phospholipid was decreased, phosphatidylcholine being the least affected and phosphatidylserine the most altered.

Measurement of dietary and dentifrice effects upon calculus accumulation rates in the domestic ferret.

Most animal models for the study of calculus accumulation and control currently use rodents or dogs. In an effort to overcome limitations inherent in the use of these species, we investigated calculus formation in domestic ferrets, a species used by King et al. in the 1940's and 1950's. Ferrets are much smaller than dogs, and, unlike rodents, can be scored while alive. In this study, we examined the kinetics of calculus formation in female ferrets fed with moist canned cat food--either plain or supplemented with sucrose--and two combinations of mineral salts. An additional group given supplemented cat food was treated twice daily with regular Crest toothpaste. Animals were sedated with a 1:1 mixture of ketamine and xylazine solutions and given a mechanical prophylaxis prior to the trial period, then scored for area and extent of calculus accumulation at two, four, six, and eight weeks thereafter. The data showed that the mineral-supplemented groups accumulated calculus at a significantly faster rate than the unsupplemented or dentifrice-treated groups, but the differences were no longer significant at eight weeks. This demonstrated that the ferret is a suitable model for the study of calculus, that dietary mineral content influenced calculogenesis, and that the application of regular dentifrice initially slowed, but did not prevent, calculus accumulation.

Reduction of calculus accumulation in domestic ferrets with two dentifrices containing pyrophosphate.

Work performed by King et al. in the 1940's and 1950's, as well as recent studies by our group, have shown that the domestic ferret is a suitable model for the study of calculus formation, offering several advantages over the rodent and dog models in current use. We have demonstrated that mineral supplementation of a moist diet accelerates calculus accumulation, and that twice-daily application of a regular dentifrice slows the initial rate of calculus formation, but permits significant accumulation by the eighth week. The present study compared calculus accumulation in female ferrets receiving mineral-supplemented cat food and a twice-daily application of either Regular Crest toothpaste (Crest), Anti-tartar Crest (Crest-AT), or Anti-tartar Colgate Gold toothpaste (Colg-AT). Animals received an ultrasonic prophylaxis, then were fed once daily for eight weeks with moist canned cat food supplemented with sucrose and mineral salts, and were scored for area and extent of calculus accumulation at four and eight weeks after prophylaxis. The data show that the groups treated with the anti-calculus dentifrices produced significantly less calculus than the group treated with regular dentifrice; the Colg-AT group also exhibited lower scores than did the Crest-AT group, especially at four weeks. These results, similar to those seen in human studies, demonstrate that the ferret is a suitable model for the study of anti-calculus dentifrices.

[Livedo-like dermatitis (Nicolau's syndrome) after injection of Copolymer-1 (Glatiramer acetate)]. / Dermite livedoïde de Nicolau après injection de Copolymère-1 (acétate de Glatiramer).

We report the first case of a 33-year-old woman with multiple sclerosis, who developed a livedo-like dermatitis after injection of Copolymere-1. This disease is characterized by the development of acute violent pain during or immediately after injection, and a livedo-like plaque followed by necrosis corresponding to an arterial ischemia by vasospasm or thrombosis. Early treatment with vasoactive and anticoagulation agents is required. Surgery may be necessary.

[Parvovirus B19 infection mimicking drug-induced hypersensitivity syndrome]. / Primo-infection à Parvovirus B 19 mimant un syndrome d'hypersensibilité médicamenteuse.

BACKGROUND: Clinical manifestations of primary parvovirus B19 infection vary greatly. Epidermal megalerythema is the most common feature. We report a particular form resembling a drug-induced hypersensitivity reaction. CASE REPORT: A 19-year-old man had a scarlatiniform eruption associated with multiple node enlargement, elevated liver enzymes and a abnormal white cell count with mononucleosis and lymphopenia, similar to that observed in hypersensitivity reactions. Seroconversion and positive PCR search for viral DNA established the diagnosis of primary parvovirus B19 infection. The spontaneous course was favorable with no recurrence at one month. DISCUSSION: The clinical features and laboratory findings in this case of parvovirus B19 infection closely resembled drug-induced hypersensitivity syndrome. The role of viral agents in the development of hypersensitivity reactions have been suggested. It is important to look for viral infections in clinical presentations mimicking drug-induced hypersensitivity.