[Prognostic factors and predictive signs of malignancy in adult dermatomyositis]. / Facteurs pronostiques et signes prédictifs de cancer au cours de la dermatomyosite de l'adulte.

INTRODUCTION: Prognosis in dermatomyositis is severe, partly due to the development of cancer. The aim of this study was to identify factors predicting cancer development and assess factors predicting reduced survival rate. PATIENTS AND METHODS: A retrospective analysis of 32 cases of dermatomyositis diagnosed on the basis of the Bohan and Peter criteria was performed. Diagnosis was certain in 7 cases, probable in 13 and possible in 5. There were thus 7 cases of pure cutaneous dermatomyositis. Clinical and laboratory data were compared between patients with and without cancer and between deceased and surviving patients. RESULTS: Overall mortality was 37.5% at 4 years, confirming the gravity of dermatomyositis. Malignancy developed in 9 patients (28.1%) leading to death in all cases, within 18 months in 8. Amyopathic dermatomyositis was observed in 2 of these patients. Necrotic skin ulcerations (p < 0.01) and pruritus (p < 0.05) were significant predictive factors for the development of cancer. Poor prognosis factors were malignancy (p < 0.001), necrotic skin ulcerations (p < 0.01), and pruritus (p < 0.05). CONCLUSION: Prognosis is poor in certain sub-groups of patients with dermatomyositis. Such patients can be identified on the basis of skin lesions, notable necrotic ulcerations.

Gastrointestinal tract involvement in polyarteritis nodosa and Churg-Strauss syndrome.

OBJECTIVE: To study the nature and incidence of gastrointestinal (GI) manifestations in polyarteritis nodosa (PAN) and Churg-Strauss syndrome (CSS) and define their therapeutic and prognostic implications. METHODS: Fifty-three patients (29 males, 24 females) affected with PAN or CSS and followed in our institution were included in a retrospective study. Patients were divided into 2 groups: patients without GI manifestations (group A) and patients with GI manifestations (group B). Among patients with GI manifestations we have studied a subgroup with a possibly poorer prognosis in whom the following symptoms were present: GI tract hemorrhage, intestinal perforation, digestive tract surgery due to PAN manifestations, intractable abdominal pain and weight loss greater than 20% of normal weight due to GI tract ischemia. RESULTS: The clinical manifestations were those that are classically encountered in PAN and CSS. Every patient fulfilled the American College of Rheumatology (ACR) criteria for PAN and CSS. Thirty-five patients without GI manifestations were included in group A and 18 patients (34%) with GI manifestations in group B. The mean age of the group at the time of diagnosis was 56.9 +/- 19.1 years (range: 21-71 years) in group A and 47.5 +/- 16.8 years (range: 12-82) in group B. GI manifestations were considered as one of the symptoms revealing PAN in 7 (13.2%) cases. Six of the 18 patients with GI manifestations had definite organ involvement related to vasculitis. Abdominal pain without characteristic organ involvement or surgical emergency was present in 12/18 patients. HBV infection was more frequently observed in group B than in group A. Survival curves showed that at 10 years, 80% of the patients in group A were alive versus 67% in group B (P not significant). For the 9 patients with severe GI manifestations, the survival curves showed that, at 10 years, 44% of them were alive versus 80% in the other group A (p < 0.001). CONCLUSIONS: GI manifestations are frequent in PAN and CSS and were present in 34% of our patients. Prognosis of PAN with GI manifestations is not statistically different than in PAN without GI involvement, except for patients with severe digestive complications.

[Salazosulfapyridine-induced eruption. Pustular erythroderma and pseudo-lymphomatous syndrome: 2 cases]. / Toxidermie à la salazosulfapyridine. Erythrodermie pustuleuse et syndrome pseudolymphomateux: 2 observations.

We report two observations of drug eruption due to salazosulfapyridine which occurred 15 to 21 days after introducing the molecule. The two patients were of Carabian origin and presented with fever, erythrodermia which became pustular and a pseudolymphomatous syndrome. Favourable outcome was observed 4 to 6 weeks later. The diagnosis of toxidermia was made based on the strong imputability of salazosulfapyridine in both cases. Severe immunoallergic reactions to this molecule have been described, including fatal cytolytic hepatitis and Lyell syndrome.

[Halo eczema around a histiocytofibroma: the Meyerson phenomenon]. / Halo eczématiforme autour d'un histiocytofibrome: phénomène de Meyerson.

We report a case of dermatitis forming a halo around a dermatofibroma. This phenomenon has initially been described around a naevocellular naevus and called Meyerson's naevus, then around other non naevus skin lesions. So far, it had not yet been reported around a dermatofibroma. The condition seems to be non-specific reaction of unknown mechanisms that does not modify the course or the prognosis of this circumscribed lesion.