Bortezomib-induced skin eruption.

Bortezomib (Velcad) is a proteasome inhibitor recently developed and mainly used for the treatment of multiple myeloma. Bortezomib represents a novel class of drugs functioning as proteasome inhibitors. Skin complications of bortezomib treatment are very frequent but poorly characterized. We describe the case of a patient who developed erythematous and edematous plaques after treatment with bortezomib. This case illustrates one of the potential reactions associated with bortezomib administration and underlines the need to recognize and report cutaneous side effects of this new drug.

[Cutaneous ulceration after an octopus bite: infection due to Vibrio alginolyticus, an emerging pathogen]. / Ulcération cutanée après morsure de poulpe: infection à Vibrio alginolyticus, un pathogène émergent.

BACKGROUND: Vibrio alginolyticus is an anaerobic Gram-negative bacillus found in normal marine flora and is considered as non pathogenic for humans. Infections due to Vibrio alginolyticus are seldom reported and can be seen after exposure to seawater or to marine animals. PATIENTS AND METHODS: A 51-year-old man was bitten on the back of the hand by an octopus that had just been caught in the Mediterranean Sea. A painful inflammatory cutaneous ulceration developed and did not heal despite treatment with bacitracin-neomycin ointment. The bacteriological smear revealed the presence of Vibrio alginolyticus. The ulceration progressively healed without sequelae after two weeks of oral ciprofloxacin therapy. DISCUSSION: The most common, though rarely reported, infections due to Vibrio alginolyticus are otitis, conjunctivitis, superficial pyodermatitis and gastroenteritis. There is an increasing obvious fact about potentially serious and life-threatening infections due to Vibrio alginolyticus especially in immunocompromised patients. This bacillus can colonize skin tissue by penetrating a skin abrasion. In our case, the patient sustained a wound from the octopus's beak. Vibrio alginolyticus should be included in the list of pathogens causing skin infections, especially if patients have been in contact with seawater in warm climate regions or with marine animals. The optimal antibiotic therapy for Vibrio alginolyticus has not been determined and antibiotic resistance could constitute an important complication.

Widespread skin necrosis associated with unfractionated heparin therapy in a patient under chronic coumarin anticoagulation.

Coumarins and heparins are commonly used for temporary or long-term anticoagulation. These molecules have potentially devastating side-effects, including widespread skin necrosis. We report the case of an elderly patient under oral anticoagulation with coumarins, who developed widespread necrotic cutaneous lesions upon introduction of intravenous and subcutaneous unfractionated heparin administration for a surgical procedure. Laboratory investigations revealed the presence of circulating antibodies directed against heparin-platelet factor 4. The lesions slowly resolved after withdrawal of heparin, whereas oral coumarin was re-introduced without complications. This case illustrates the rare occurrence of skin necrosis as a result of unfractionated heparin in a patient under chronic coumarin medication. Recognition of this rare complication and appropriate laboratory testing is mandatory for prompt institution of alternative anticoagulant therapies.