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1.
J Med Case Rep ; 17(1): 1, 2023 Jan 03.
Article in English | MEDLINE | ID: mdl-36597169

ABSTRACT

BACKGROUND: Necrobiosis lipoidica located to the breast; without evidence of glucose intolerance, is extremely rare, and its association to Crohn's disease is not usual. CASE PRESENTATION: We report an interesting case of an association of necrobiosis lipoidica of the breast and Crohn's disease in a 54-year-old Moroccan woman. Skin necrobiotic changes are a characteristic feature in necrobiosis lipoidica, but they are exceptional in metastatic Crohn's disease, since there are only three published cases of necrobiotic skin lesions on the lower leg resembling erythema nodosum in metastatic Crohn's disease. CONCLUSIONS: On the basis of this rare observation, necrobiosis lipoidica without evidence of glucose intolerance should be recognized as a possible cutaneous manifestation or association of Crohn's disease.


Subject(s)
Crohn Disease , Glucose Intolerance , Necrobiosis Lipoidica , Skin Diseases , Female , Humans , Middle Aged , Necrobiosis Lipoidica/complications , Necrobiosis Lipoidica/diagnosis , Necrobiosis Lipoidica/pathology , Crohn Disease/complications , Crohn Disease/pathology , Glucose Intolerance/complications , Glucose Intolerance/pathology , Skin/pathology , Skin Diseases/pathology
3.
Cells ; 10(4)2021 03 31.
Article in English | MEDLINE | ID: mdl-33807303

ABSTRACT

Sarcoidosis is a multi-system disease of unknown etiology characterized by the formation of granulomas in various organs. It affects people of all ethnic backgrounds and occurs at any time of life but is more frequent in African Americans and Scandinavians and in adults between 30 and 50 years of age. Sarcoidosis can affect any organ with a frequency varying according to ethnicity, sex and age. Intrathoracic involvement occurs in 90% of patients with symmetrical bilateral hilar adenopathy and/or diffuse lung micronodules, mainly along the lymphatic structures which are the most affected system. Among extrapulmonary manifestations, skin lesions, uveitis, liver or splenic involvement, peripheral and abdominal lymphadenopathy and peripheral arthritis are the most frequent with a prevalence of 25-50%. Finally, cardiac and neurological manifestations which can be the initial manifestation of sarcoidosis, as can be bilateral parotitis, nasosinusal or laryngeal signs, hypercalcemia and renal dysfunction, affect less than 10% of patients. The diagnosis is not standardized but is based on three major criteria: a compatible clinical and/or radiological presentation, the histological evidence of non-necrotizing granulomatous inflammation in one or more tissues and the exclusion of alternative causes of granulomatous disease. Certain clinical features are considered to be highly specific of the disease (e.g., Löfgren's syndrome, lupus pernio, Heerfordt's syndrome) and do not require histological confirmation. New diagnostic guidelines were recently published. Specific clinical criteria have been developed for the diagnosis of cardiac, neurological and ocular sarcoidosis. This article focuses on the clinical presentation and the common differentials that need to be considered when appropriate.


Subject(s)
Sarcoidosis/diagnosis , Sarcoidosis/pathology , Diagnosis, Differential , Humans , Organ Specificity , Phenotype , Sarcoidosis/complications , Sarcoidosis/diagnostic imaging
7.
J Am Acad Dermatol ; 74(6): 1153-9, 2016 Jun.
Article in English | MEDLINE | ID: mdl-26965410

ABSTRACT

BACKGROUND: Paradoxical hidradenitis suppurativa (HS) induced by biologic agents (BA) is scarcely reported. OBJECTIVE: We sought to describe the clinical characteristics and outcome of patients developing paradoxical HS under BA. METHODS: This was a multicenter nationwide retrospective study asking physicians to report all cases of HS, confirmed by a dermatologist, occurring during treatment of an inflammatory disease by a BA. RESULTS: We included 25 patients (15 inflammatory rheumatism, 9 Crohn's disease, 1 psoriasis) treated by 5 BA (adalimumab = 12, infliximab = 6, etanercept = 4, rituximab = 2, tocilizumab = 1). Median duration of BA exposure before HS onset was 12 (range 1-120) months. Patients were mostly Hurley stage I (n = 13) or II (n = 11). Simultaneously to HS or within 1 year, 11 patients developed additional inflammatory diseases, including paradoxical reactions (psoriasis = 9, Crohn's disease = 3, alopecia areata = 1, erythema elevatum diutinum = 1). Complete improvement of HS was more frequently obtained after BA discontinuation or switch (n = 6/10, 60%) rather than maintenance (n = 1/14, 7%). Reintroducing the same BA resulted in HS relapse in 3 of 3 patients. LIMITATIONS: Retrospective nature and lack of complete follow-up for some patients are limitations. CONCLUSION: HS is a rare paradoxical adverse effect of BA, but fortuitous association cannot be excluded in some cases. We observed a trend toward better outcome when the BA was discontinued or switched.


Subject(s)
Anti-Inflammatory Agents, Non-Steroidal/adverse effects , Biological Products/adverse effects , Drug Eruptions/etiology , Hidradenitis Suppurativa/chemically induced , Adalimumab/adverse effects , Adolescent , Adult , Antibodies, Monoclonal, Humanized/adverse effects , Arthritis/drug therapy , Crohn Disease/chemically induced , Crohn Disease/drug therapy , Drug Substitution , Etanercept/adverse effects , Female , Humans , Infliximab/adverse effects , Male , Middle Aged , Psoriasis/chemically induced , Psoriasis/drug therapy , Recurrence , Retrospective Studies , Rituximab/adverse effects , Withholding Treatment , Young Adult
9.
Presse Med ; 39(5): 548-52, 2010 May.
Article in French | MEDLINE | ID: mdl-19932000

ABSTRACT

Because of its excellent diagnostic performance, whole-body MRI will probably become an alternative to or replacement for positron emission tomography and computed tomography (PET-CT). The sensitivity of diffusion sequences is high. Whole body MRI is used increasingly often in oncology, for initial or follow-up staging, finding primary tumors after identifying metastases, staging for pregnant woman and children, and therapeutic follow-up. Advantages of whole-body MRI over PET-CT include the absence of irradiation as well as the greater availability, and lower cost of MRI.


Subject(s)
Diffusion Magnetic Resonance Imaging/methods , Neoplasms/diagnosis , Whole Body Imaging/methods , Child , Contrast Media , Diffusion Magnetic Resonance Imaging/economics , Female , Follow-Up Studies , Humans , Image Processing, Computer-Assisted/methods , Neoplasm Metastasis , Neoplasm Staging , Positron-Emission Tomography/methods , Predictive Value of Tests , Pregnancy , Sensitivity and Specificity , Tomography, X-Ray Computed/methods , Whole Body Imaging/economics
12.
Presse Med ; 32(33): 1557-8, 2003 Oct 11.
Article in French | MEDLINE | ID: mdl-14576594

ABSTRACT

INTRODUCTION: Syphilis remains a current infection in France, with an increase in cases associated with the increase in sexual practices at risk. OBSERVATION: An HIV-seropositive homosexual male presented with a perturbed hepatic profile and roseola-like exanthema 15 days after starting treatment with Trizivir. Because of the combination of hepatitis and cutaneous eruption evoking hypersensitivity to abacavir, treatment was suspended, but no improvement was noted. The diagnosis of syphilitic hepatitis associated with roseola was made following a sero-conversion and improvement was obtained with benzathine-penicillin and the re-introduction of Trizivir without further problem. COMMENTS: This case report underlines the possibility of discovering syphilis when confronted with cholestatic and cytolytic hepatitis that regresses with penicillin and is isolated or associated with evocative cutaneous signs.


Subject(s)
Anti-HIV Agents/therapeutic use , Chemical and Drug Induced Liver Injury/etiology , Dideoxynucleosides/therapeutic use , HIV Seropositivity/drug therapy , Lamivudine/therapeutic use , Syphilis/diagnosis , Zidovudine/therapeutic use , Adult , Chemical and Drug Induced Liver Injury/drug therapy , Dideoxynucleosides/adverse effects , Drug Combinations , Drug Therapy, Combination , Ethylenediamines/therapeutic use , HIV Seropositivity/complications , Humans , Lamivudine/adverse effects , Male , Syphilis/drug therapy , Zidovudine/adverse effects
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