Late lethal hepatitis B virus reactivation after rituximab treatment of low-grade cutaneous B-cell lymphoma.

The chimeric anti-CD20 monoclonal antibody, rituximab, is a promising treatment for cutaneous B-cell lymphomas. Classically used in combination with a multiagent-chemotherapy regimen, it can sometimes give excellent results alone. Because of its selective action on B lymphocytes, it is considered a moderate immunosuppressant in terms of infection. We describe a woman with relapsed cutaneous follicular centre B-cell lymphoma and secondary lymph-node involvement treated with rituximab alone, which induced a complete remission. One year later, she experienced a fatal hepatitis B virus (HBV) reactivation. Several such HBV reactivations were reported after combined rituximab and multiagent chemotherapy for B-cell lymphomas. This is the first case of HBV reactivation occurring during the year following rituximab monotherapy in the absence of any other immunosuppressive factor.

[Herpetic-like worsening of an epidermolysis bullosa simplex during pregnancy]. / Aggravation herpétiforme d'une épidermolyse bulleuse héréditaire simple au cours de la grossesse.

INTRODUCTION: Episodes of hereditary epidermolysis bullosa simplex are usually provoked by repeated cutaneous traumas or exposure to heat. We report a case of hereditary epidermolysis bullosa simplex worsened during pregnancy. OBSERVATION: A 21 year-old woman suffering from hereditary epidermolysis bullosa simplex presented with unusual symptoms in the form of an extensive vesicular-bullous eruption at two months of her first pregnancy. Standard histological examination revealed an eosinophilic infiltrate in the bullae. The global results of the initial examinations suggested a herpetic-like episode of epidermolysis bullosa as is observed during the Dowling-Meara form of the disease. DISCUSSION: Various physiopathological hypotheses can be advanced to explain the worsening of the eruption during pregnancy: a mechanical origin with scratching of pruritus, enhanced fragility of the inter-keratinocyte bridges secondary to edema provoked by salt-water retention or a loss in antigenic tolerance to muted keratins 5 and 14, as in pemphigoid gestationis. The presence of eosinophils in the dermis and epidermis may also participate directly in the formation of bullae due to the release of cationic proteins.

[Non infectious skin conditions associated with diabetes mellitus: a prospective study of 308 cases]. / Dermatoses non infectieuses au cours du diabète sucré: étude prospective de 308 malades.

INTRODUCTION: Non-infectious dermatoses during diabetes appear frequent if one refers to some of the studies in the literature that have attempted to assess its prevalence. PATIENTS AND METHODS: From November 2000 to November 2001, 308 randomly selected, hospitalized, diabetic patients were examined. The data were collected prospectively and systematically in a pre-established questionnaire. Statistical analysis included a descriptive and univariate analysis. RESULTS: 206/308 diabetics (67 p. 100) exhibited at least one non-infectious dermatitis, the most frequent of which was cutaneous xerosis (39 p. 100), diabetic dermopathy (24 p. 100), facial erythrosis (24 p. 100), purpural and pigmented capillaritis of the legs (20 p. 100), xanthochromia (12 p. 100) pseudo-scleroderma (8 p. 100) and acanthosis nigricans (7 p. 100). The non-infectious dermatoses were globally more frequent in type II diabetic patients exhibiting at least one microvascular complication. DISCUSSION: This study is the first French prospective work on the subject. We found a prevalence of non-infectious dermatoses during diabetes close to that of the major studies in the literature. Some of these dermatoses are markers of macrovascular (acanthosis nigricans, purpural and pigmented capillarity) or microvascular (xerosis, acanthosis nigricans, purpural and pigmented capillarity, Dupuytren's disease) complications for type II diabetes or are markers of auto-immunity (alopecia areata, vitiligo) for type I.

[Herpes simplex in children. Clinical manifestations, diagnostic value of clinical signs, clinical course]. / Herpès cutanéo-muqueux: particularités chez l'enfant. Clinique, valeur diagnostique de la clinique, évolution.

Herpetic gingivostomatitis (HGS) is the predominant manifestation of cutaneomucosal herpes in children with HSV1 primary infection before the age of 3 years. The infection is self limiting and lasts 10 to 14 days. Pain and dysphagia are particularly important during the first week of infection and may necessitate parenteral rehydratation and administration of antalgesics. HGS in the young child causes substantial morbidity leading to hospital and social costs (work stoppage for parents). The clinical course is generally benign with the exception of forms with important extension, eczema, herpeticum Kaposi-Juliusberg pustulosis observed at this age only in children with atopic dermititis. Other severe forms are observed in the neonate and immunodepressed subject, which can also be caused by HSV1. Forms with little or not clinical manifestation predominate and generally go undiagnosed, explaining the asymptomatic viral excretion observed in the saliva or other secretions (ocular, genital secretions). Despite the sterotypic nature of the clinical expression, HGS is still often undiagnosed both by general practitioners and pediatricians. This lack of diagnosis generally has few consequences due to the benign course in a few days, but the infection can have an important psychological and social leading to significant healthcare costs. Moderate and severe forms require medical care. Aciclovir should be prescribed if the diagnosis is made early (3 days) in combination with symptomatic care. Studies of the medical and economic impact of herpetic gingivostomatis should be conducted.