[Subacute meningococcaemia during adalimumab therapy]. / Méningococcémie subaiguë sous adalimumab.

INTRODUCTION: Subacute or chronic meningococcaemia is an invasive infection by Neisseria meningitidis characterized by fever lasting between a few days (subacute) and a week or more (chronic), cutaneous rash and arthralgia, without meningitis. PATIENTS AND METHODS: A 59-year-old woman was admitted for a fever with cutaneous rash. She had a history of Crohn's disease diagnosed in 2016 and treated with adalimumab for 14 months at a dosage of 40mg/week. For 3 days, she presented fever with a temperature of up to 40°C associated with a non-itchy erythematous-papular eruption on all four limbs, especially the lower limbs. The lesions were mildly painful on palpation. The rest of the clinical examination was unremarkable. The patient did not have arthralgia or neurological symptoms, and in particular, she exhibited no meningeal syndrome. Blood cultures as well as PCR on a skin biopsy specimen confirmed the diagnosis of meningococcaemia. The patient was treated with ceftriaxone 2g/day for 4 days then amoxicillin 12g/day for 4 days. A favourable outcome was quickly achieved, and the condition subsided without sequelae. DISCUSSION: We report the first case of subacute meningococcaemia in a patient treated with anti-TNF alpha therapy. This case concerns the role of biotherapies, and more particularly anti-TNF alpha therapy, in the occurrence of particular infections but also in changes in their clinical presentation and clinical course, as in the present case without arthralgia.

[Normal skin biopsy as a tool for extra-cutaneous disorders]. / Indications extra-cutanées de la biopsie de peau normale.

Biopsies of apparently healthy skin can contribute to the diagnosis of an internal disorder in a patient or in the detection of a potential disease carrier. Herein, we review those diseases for which dermatologists may be asked to perform a biopsy on normal skin where analysis by optical microscopy, immunofluorescence or electronic microscopy may result in diagnosis of an "internal" disease. Diseases for which biopsies are required for cell cultures (e.g. fibroblasts cultures), clonality testing or chromosomal analysis are not discussed here.

Physicians involved in the care of patients with high risk of skin cancer should be trained regarding sun protection measures: evidence from a cross sectional study.

BACKGROUND: Knowledge, regarding sun protection, is essential to change behaviour and to reduce sun exposure of patients at risk for skin cancer. Patient education regarding appropriate or sun protection measures, is a priority to reduce skin cancer incidence. OBJECTIVE: The aim of this study was to evaluate the knowledge about sun protection and the recommendations given in a population of non-dermatologists physicians involved in the care of patients at high risk of skin cancer. MATERIALS AND METHODS: This study is a cross-sectional study. Physicians were e-mailed an anonymous questionnaire evaluating the knowledge about risk factors for skin cancer, sun protection and about the role of the physician in providing sun protection recommendations. RESULTS: Of the responders, 71.4% considered that the risk of skin cancer of their patients was increased when compared with the general population. All the responders knew that UV-radiations can contribute to induce skin cancers and 71.4% of them declared having adequate knowledge about sun protection measures. A proportion of 64.2% of them declared that they were able to give sun protection advices: using sunscreens (97.8%), wearing covering clothes (95.5%), performing regular medical skin examination (91.1%), to avoid direct sunlight exposure (77.8%), avoiding outdoor activities in the hottest midday hours (73.3%) and practising progressive exposure (44.4%). CONCLUSION: Non-dermatologist physicians reported a correct knowledge of UV-induced skin cancer risk factors. The majority of responders displayed adequate knowledge of sun protection measures and declared providing patients with sun protection recommendation on a regular basis. Several errors persisted.

[Hand-foot syndrome: A new side effect of erlotinib]. / Syndrome mains-pieds : nouvel effet secondaire de l'erlotinib.

BACKGROUND: Erlotinib (Tarceva) belongs to the family of epidermal growth receptor factor (EGFR) inhibitors. Used in the treatment of some cancers, it is responsible for several cutaneous side effects. We report a case of hand-foot syndrome, which has not previously been described with this drug to our knowledge. PATIENTS AND METHODS: A 65-year-old patient was given erlotinib for lung cancer and after the first month of treatment, he developed severe hand-foot syndrome. DISCUSSION: Hand-foot syndrome consists of abrupt bilateral and painful acral erythema associated with dysesthesia. It is a dose-dependent side effect of certain cytostatic drugs. It may sometimes require withdrawal of the causative drug. Care must be taken to identify the early signs of hand-foot syndrome in patients treated with erlotinib.

[Bullous pemphigoid sparing acquired lymphedema]. / Une pemphigoïde bulleuse épargnant un lymphoedème acquis.

BACKGROUND: Bullous pemphigoid is an autoimmune disease, common in the elderly and generally of symmetrical and systemic localization. We report a case with sparing of the lower limb and acquired lymphedema secondary to lymph node surgery. CASE REPORT: A 74-year-old woman was hospitalized for a bullous eruption. The left lower limb was completely spared and was unaffected by pruritus. Acquired lymphedema was seen in this limb secondary to lymph node surgery. Standard histopathology tests confirmed the diagnosis of bullous pemphigoid with subepidermal blistering, while a direct immunofluorescence antibody test showed linear binding of IgG and C3 throughout the basement membrane. Western blotting revealed anti-BPAg2 antibodies. Skin biopsy on the lymphedema spared by the disease revealed no inflammatory infiltrate in the dermis. However, linear binding of anti-IgG and anti-C3 autoantibodies was observed. DISCUSSION: Other cases of localized bullous pemphigoid appearing on body areas treated by UV or radiotherapy have been reported. Cases of bullous pemphigoid with predilection for areas of lymphedema have also been previously described: the hypothesis has been advanced of reduced lymphatic flow, with increased antigen-antibody contact enabling better binding. Our case is original and, given the protective nature of this lymphedema, suggests two hypotheses. There could be deterioration of local cellular immunity, with decreased activation of T lymphocytes. They could also be impairment of nervous conduction, as suggested by the absence of pruritus, with partial or total inhibition of neurogenic inflammation.

Primary Gougerot-Sjögren syndrome: a dermatological approach.

Gougerot-Sjögren syndrome (GSS) is a chronic heterogeneous non-organ-specific autoimmune disease, encompassing a wide spectrum of clinical manifestations. It is characterized by a lymphocytic infiltration of the exocrine glands, also called epitheliitis, resulting in xerostomia and keratoconjunctivitis sicca. The skin can also be involved; for example, xerosis is a consequence of epitheliitis. Dermatological consequences of polyclonal reactivity are vasculitis and manifestations of B-cell proliferation vary from plasma cell infiltrates to B-cell lymphoma.

Intralesional therapy with anti-CD20 monoclonal antibody rituximab: local and systemic efficacy in primary cutaneous B-cell lymphoma.

Rituximab (MabThera, Roche) is a chimeric monoclonal antibody directed against the CD20 antigen. Its efficacy and safety were first demonstrated in the treatment of systemic B-cell lymphomas. We report the use of intralesional injections of rituximab into some but not all cutaneous lesions in a patient with multiple primary cutaneous follicular centre B-cell lymphoma. This treatment resulted in tumour regression, even of the lesions that had not been injected. We therefore hypothesize that there is systemic diffusion of rituximab from injected sites despite the low doses injected locally, or the induction of a specific antitumour immune response acting systemically.

Cutaneous manifestations of primary Sjögren's syndrome are underestimated.

The association of kerato-conjunctivitis sicca and xerostomia has been termed Sjogren's syndrome (SS). Although this disease is referred to as a non-organ-specific autoimmune condition, the vast majority of the deleterious effects of primary SS are restricted to the exocrine glands. Among them, the lacrymal and salivary glands are at the foreground, owing to the severity of the objective consequences and the importance of the subjective manifestations. As a result, cutaneous manifestations are minimized, albeit relatively common. We have carefully analyzed the literature to draw up an inventory of the possible skin complications of this syndrome. In addition to xerosis and epidermal IgG deposits, they include vasculitis and cutaneous B cell lymphoma. Alopecia, vitiligo and papular lesions have also been reported to be associated with primary SS.