[Schnitzler syndrome]. / Le syndrome de Schnitzler.

This is the case report of a 57-year-old women with a 10-year long history of urticarial-like exanthema and monoclonal immunoglobulin M Kappa gammopathy, associated to arthralgia with pain of the lower limbs. A cutaneous biopsy and an inflammatory syndrome on laboratory testing helped to diagnose an urticarial vasculitis. A treatment with colchicine was set up but the response to therapy was not satisfactory. The diagnosis of Schnitzler syndrome was eventually suggested based on the combination of monoclonal gammopathy, urticarial and pain. A therapy with anakinra, an interleukin-1-receptor antagonist (IL-1), was started accordingly. The response was remarkable on skin rash, bone pain and laboratory testing including inflammatory syndrome.

Le cas présenté est celui d'une femme de 57 ans avec une histoire, longue de 10 ans, d'exanthème de type urticaire associé à des douleurs aux membres inférieurs et à une protéine monoclonale de type immunoglobuline M (IgM) Kappa. Une biopsie cutanée et un syndrome inflammatoire biologique ont permis de poser le diagnostic de vascularite mixte. La patiente est alors traitée par colchicine. Durant les années qui suivent, la colchicine n'a apaisé que modérément les plaintes. Un syndrome de Schnitzler est finalement évoqué face à la combinaison d'urticaire et de protéine monoclonale. Cette piste envisagée, un traitement par anakinra, un antagoniste des récepteurs de l'interleukine-1 (IL-1) est instauré, entraînant la disparition complète de l'urticaire.

[Cutaneous adverse effects of TNFalpha antagonists]. / Les effets cutanés indésirables des antagonistes du TNFalpha.

The TNFalpha antagonists, including adalimumab, etanercept and infliximab, represent a class of anti-inflammatory and immunosuppressive drugs. Although cutaneous adverse effects are uncommon, they are varied. There is no particular risk profile to develop cutaneous adverse effects. The principal acute side effects are injection site reactions and pruritus. The major long term cutaneous side effects are infectious and inflammatory conditions. Neoplastic skin diseases are exceptional. The association with other immunosuppressive agents can increase the risk of developing cutaneous adverse effects. Some adverse effects, such as lupus erythematosus, require immediate withdrawal of the biological treatment, while in other cases temporary withdrawal is sufficient. The majority of the other cutaneous adverse effects can be dealt without interrupting biologic treatment. Preclinical and clinical investigations revealed that the new biologics, aiming IL12/23, IL23 and IL17, present a similar profile of cutaneous adverse effects, although inflammatory skin reactions may be less often encountered compared to TNFalpha antagonists.

The Pott's puffy tumor: an unusual complication of frontal sinusitis, methods for its detection.

This is a case report of a Pott's puffy tumor, characterized by a subperiosteal abscess associated with frontal bone osteomyelitis, as a consequence of a frontal sinusitis, in a 15-year-old boy. Pott's puffy tumor is a rare condition usually seen as a complication of frontal sinusitis and more commonly described in children. Given that, superficial temporal artery pseudoaneurysms might be interpreted as a cyst or lipoma, it is imperative that physicians be aware of their presentation.