Value of standard laboratory tests for the early recognition of group A beta-hemolytic streptococcal necrotizing fasciitis.

The laboratory data for 17 patients with group A beta-hemolytic streptococcal necrotizing fasciitis (GAS NF) were compared with data for 145 patients hospitalized for cellulitis during the same period. Admission values of C-reactive protein and creatine kinase were higher for patients in the group with GAS NF than for patients in the group with cellulitis (P<.001), suggesting that standard laboratory tests may be useful for the early differential diagnosis of GAS NF and cellulitis.

Carcinoma of the glans penis arising 20 years after lichen sclerosus.

Lichen sclerosis (LS) is an inflammatory disease of incompletely characterized pathogenesis. The relation between LS and carcinoma is well known in women, but in men it is still a matter of debate whether LS is a premalignant lesion or not. We describe a case of LS of the glans penis which occurred in 1976. Within the next 20 years, the patient developed carcinoma at this site.

Dirofilariasis, a rare, usually imported dermatosis.

Dirofilariasis is an animal filariasis, exceptionally transmitted to man. The clinical manifestations are usually one or a few subcutaneous nodules which are frequently mistaken for lipomas or epidermic cysts. Inside the nodule may be found a worm, adult but immature. There are no systemic reactions and the only required treatment is surgical excision of the nodules.

Chronic arsenicism: criminal poisoning or drug-intoxication? Report of two cases.

We report two cases with chronic arsenicism. The first one is a young 37-year-old woman who presents leucomelanoderma, plantar keratoderma, polyneuropathy of the legs and transversal striae of the nails. After investigations, criminal intoxication with arsenic caused by her own sister was discovered. The second case is a 42-year-old man who had developed plantar keratoderma, arsenical keratoses and two squamous cell epitheliomas 10 years after a 2-year treatment with Fowler's solution for androgenetic alopecia.

[Streptococcus beta hemolytic necrotizing fasciitis. 5 cases in the Brussels area]. / Fasciite nécrosante à streptocoque beta hémolytique du groupe A. Cinq cas dans la région bruxelloise.

In the Brussels area five cases of necrotizing fasciitis occurred during the past two years in patients devoid of any pathology likely to lower the immune defence mechanisms. Alcoholism and the use of non-steroidal anti-inflammatory drugs seem to act as contributory factors. Necrotizing fasciitis develops alone or as complication of a pre-existent dermo-hypodermic infection. A massive use of antibiotics and a wide surgical slitting up failed to prevent a fatal issue in all five patients. Extremely early massive surgery remains vital in this disease.

[Epidemiology and etiopathogeny of necrotizing fasciitis and streptococcal shock syndrome]. / Epidémiologie et étiopathogénie des fasciites nécrosantes et du syndrome de choc streptococcique.

A significant increase in the frequency of necrotizing fasciitis caused by streptococci of group A has recently been noted. The disease usually appears in individuals without obvious risk factors. The initial lesion is often quite ordinary, and the evolution towards a toxic shock very swift. This evolution can be summarized as follows: 1) localized infection; 2) bacteraemia with circulating toxins and soft tissue necrosis; 3) production of cytokines by the immune cells of the host, leading to a rapidly irreversible toxic shock Serotypes 1, 3, 12 and 28 of group A streptococcus are usually involved. The virulence of some serotypes might be explained by the acquisition of a toxic gene. The sensitivity of the host is linked to the genetic expression of the V. beta. elements on the surface of lymphocytes. Antibiotics cannot save the patient when necrotizing fasciitis is installed. Surgery must be massive and performed early.