Onychomycosis due to Exophiala jeanselmei.

BACKGROUND: Exophiala jeanselmei is a dematiaceous fungus that may cause invasive diseases, particularly among immunocompromised hosts. Most reports mention cutaneous or subcutaneous lesions, but no case of nail involvement due to this fungus has been reported until now. CASE REPORT: A 60-year-old man presented with hyperkeratosis and black coloration of the nails of the two thumbs and the two big toes of 4 years' duration. He was a renal transplant recipient and had been treated with prednisone and azathioprine. E. jeanselmei was present on direct examination, then isolated in cultures on repeated samplings from all pathologic nails. He was cured after 6 months of treatment with itraconazole. COMMENTARY: We describe the first case of nail infection due to E. jeanselmei. Itraconazole, which provides a broad spectrum of action on fungal species and achieves high levels of active substance in many tissues, including the nails, appeared to be efficient upon such a nail localization of E. jeanselmei.

Intravascular metastatic melanoma of the vena saphena magna.

BACKGROUND: Melanoma blood vessel metastases are very uncommon. We report the first recorded case of intravascular metastatic melanoma of the vena saphena magna. CASE REPORT: A 74-year-old woman presented with a swelling of the upper third of her left thigh and was suspected of superficial thrombophlebitis. Two intravascular black masses were excised in the vena saphena magna. Histopathologic examination showed an endovascular metastatic melanoma positively staining for HMB45 and S-100 proteins. Acral-lentiginous melanoma of her big toe was then found. Subcutaneous lymph node and chest metastases were discovered and treatment with dacarbazine was initiated, followed by treatment with fotemustine. The patient died 21 months after the diagnosis was made. CONCLUSIONS: Only a few cases of blood vessel metastatic melanoma have been reported. We here report the first recorded case, to our knowledge, of intravascular metastatic melanoma of the vena saphena magna. Surgical exploration allowed rapid diagnosis, and histological examination confirmed the intravascular nature of a hematogenous melanoma metastasis. This case clearly illustrates the need for histologic examination of any thrombotic material.

Increase in total blood antioxidant status and selenium levels in black patients with active vitiligo.

BACKGROUND: Oxidative stress could be an important phenomenon leading to melanocyte death in vitiligo. The accumulation of hydrogen peroxide (H2O2) and low catalase levels have recently been demonstrated in the epidermis of vitiligo patients. Few abnormalities of antioxidants have been found in the blood of patients with vitiligo, except for an elevation of selenium. No studies on oxidative stress have been performed so far on patients with skin phototype VI (Fitzpatrick classification). AIM: To study the blood antioxidant status of black patients with active generalized vitiligo. METHODS: Randox total antioxidant status, selenium, ferritin, transferrin, ceruloplasmin, tocopherol, and retinol levels were evaluated in blood samples obtained from 11 dark-skinned patients from the French West Indies (Isle of Martinique) with recent active lesions of vitiligo and from 11 age- and sex-matched healthy volunteers. RESULTS: Total blood antioxidant status and selenium levels were significantly increased in vitiligo patients, compared to those in sex- and age-matched controls (P < 0.01 and P < 0.02, respectively). Blood levels of ferritin, transferrin, ceruloplasmin, retinol, and tocopherol were not significantly modified. CONCLUSIONS: This is the first report on the global blood antioxidant status in vitiligo. The increase in total blood antioxidant status observed in black patients was an unexpected result that needs to be confirmed and explained by further studies. The spontaneous increase in selenium levels could be of interest, as it has been recommended in the treatment of vitiligo.