Síndrome semblant a la de Gianotti-Crosti secundària a mollusc contagiós / Síndrome similar al de Gianotti-Crosti secundario a molusco contagioso / Gianotti-Crosti-like syndrome secondary to molluscum contagiosum

Introducció: El mol·lusc contagiós és una malaltia cutàniacomuna en la infància, d’origen viral, que consisteix enl’aparició de pàpules perlades amb umbilicació central. Enalguns casos pot originar reaccions inflamatòries secundàries que cal conèixer per fer un diagnòstic correcte, com ladermatitis per mol·lusc o la síndrome semblant a la deGianotti-Crosti. Cas clínic: Nen de 4 anys amb antecedent d’infecció permolluscum contagiosum que inicia lesions inflamatòries acolzes i genolls, suggestives de reacció inflamatòria secundària, anomenada síndrome semblant a la de Gianot-ti-Crosti. Es va fer un tractament amb corticoides tòpics ila resolució de les lesions va ser completa. Comentari: La síndrome semblant a la de Gianotti-Crostisecundària a molluscum contagiosum és una reacció inflamatòria poc freqüent que cal tenir present per fer un diagnòstic acurat i oferir un tractament adequat. Tendeix a laresolució espontània, tot i que en casos simptomàtics potnecessitar tractament amb corticoides tòpics i antihistamínic oral.(AU)

Introducción: El molusco contagioso es una enfermedad cutáneacomún en la infancia, de origen viral, que consiste en la apariciónde pápulas perladas con umbilicación central. En algunos casospuede originar reacciones inflamatorias secundarias que es necesario conocer para hacer un correcto diagnóstico, como la dermatitis por molusco o el síndrome similar al de Gianotti-Crosti. Caso clínico. Niño de 4 años con antecedente de infección pormolluscum contagiosum que inicia lesiones inflamatorias en codosy rodillas, sugestivas de reacción inflamatoria secundaria, denominada síndrome similar al de Gianotti-Crosti. Se realizó tratamientocon corticoides tópicos con resolución completa de las lesiones. Comentario: El síndrome similar al de Gianotti-Crosti secundario amolluscum contagiosum es una reacción inflamatoria poco frecuente que debemos tener presente para hacer un diagnósticopreciso y ofrecer un tratamiento adecuado. Tiende a la resolución espontánea, aunque en casos sintomáticos puede precisar tratamiento con corticoides tópicos y antihistamínico oral.(AU)

Introduction: Molluscum contagiosum is a common skin disease inchildren. The infection is caused by the molluscum contagiosumvirus. It presents as single or multiple spherical, shiny, pearlywhite papules with a central dimple. In some cases, it can producesecondary inflammatory reactions that it is necessary to recognizesuch as molluscum dermatitis or Gianotti-Crosti-like syndrome. Case report: A four year old patient with a history of molluscumcontagiosum infection developed erythematous lesions in the elbows and knees, suggestive of a secondary inflammatory reaction,Gianotti-Crosti-like syndrome. Treatment with topical corticosteroids was administered with full resolution of the skin lesions. Comments: Gianotti-Crosti-like syndrome secondary to molluscumcontagiosum is a rare inflammatory reaction that pediatriciansneed to be aware of for a proper diagnosis and treatment. Thissyndrome tends to resolve spontaneously, although in symptomaticcases treatment with topical corticosteroids and oral antihistaminemay be required.(AU)

Enfermedad de still en el adulto: relato de caso y revisión literaria / Still's disease in adults: case report and literary review

La enfermedad de Still se caracteriza por ser una enfermedad inflamatoria, sis-témica, rara, sin etiología y patogénesis establecidas. Su tríada clásica de manifesta-ción es fiebre alta de origen desconocido, artralgia persistente y erupción cutánea de color salmón, además de manifestaciones sistémicas. El diagnóstico es clínico y requiere la exclusión de enfermedades infecciosas, neoplásicas y otras enfermeda-des autoinmunes, pues no posee marcadores biológicos específicos. Los exámenes de laboratorio son inespecíficos y muestran una actividad inmunológica exacerbada. El tratamiento incluye medicamentos antiinflamatorios no esteroideos, corticosteroi-des, inmunosupresores, gammaglobulina intravenosa y agentes biológicos. Describi-mos el caso de un paciente de 25 años con fiebre vespertina diaria sin foco conocido y artralgia migratoria, sin erupciones cutáneas.

Still's disease is characterized by being a rare systemic inflammatory disease with no established etiology and pathogenesis. Its classic manifestation triad is high fever of unknown origin, persistent arthralgia and salmon-colored rash, in addition to systemic manifestations. The diagnosis is clinical and requires the exclusion of infec-tious, neoplastic and other autoimmune diseases, as it does not have specific biologi-cal markers. Laboratory tests are non-specific and show exaggerated immune activity. Treatment includes non-steroidal anti-inflammatory drugs, corticosteroids, immu-nosuppressants, intravenous gammaglobulin and biological agents. We describe the case of a 25-year-old patient with daily afternoon fever with no known focus and migratory arthralgia without rash.

Predictors of Tumor Response to Cetuximab and Panitumumab in 116 Patients and a Review of Approaches to Managing Skin Toxicity.

INTRODUCTION AND OBJECTIVES: Cetuximab and panitumumab are monoclonal antibodies that target the epidermal growth factor receptor (EGFR) in the treatment of metastatic colorectal cancer. Most patients develop a papulopustular rash, which may predict tumor response. We studied whether the other adverse cutaneous effects associated with these monoclonal antibodies are also clinical predictors of response. We also reviewed publications describing approaches to treating the papulopustular rash since no evidence-based guidelines have yet been published. MATERIAL AND METHODS: We performed a retrospective study of 116 patients with metastatic colorectal cancer receiving anti-EGRF therapy with cetuximab or panitumumab at Hospital Universitario Donostia. RESULTS: In total, 81.9% of the patients developed a papulopustular rash. Patients who received the most cycles of treatment with the EGFR inhibitor were at the highest risk of developing the rash, and these patients also had the most severe rash reactions (P=.03). All of the patients who exhibited a complete tumor response had the rash, and the incidence of rash was lower in patients with poor tumor response (P=.03). We also observed an association between tumor response and xerosis (53.4% of the patients who developed xerosis also exhibited tumor response, P=.002). The papulopustular rash was managed according to an algorithm developed by our department. CONCLUSIONS: Severe papulopustular rash and xerosis may be clinical predictors of good response to anti-EGFR therapy. Patients who develop a papulopustular rash should be treated promptly because suboptimal treatment of this and other adverse effects can lead to delays in taking the prescribed anti-EGFR dose or to interruption of therapy.

Meningococcemia crónica / Chronic menigococcemia

La meningococcemia crónica es una forma clínica infrecuente dentro del espectro de infecciones producido por Neisseria meningitidis. Clásicamente esta forma clínica se caracteriza por fiebre, lesiones cutáneas, compromiso articular, y desarrollo en hemocultivo de la bacteria responsable, habitualmente con ausencia de compromiso meníngeo. Generalmente afecta a adultos jóvenes previamente sanos. Se desconoce la razón por la cual estos pacientes, a diferencia de los que presentan meningitis aguda por Neisseria meningitidis y meningococcemia aguda, pueden sobrevivir sin complicaciones durante semanas en ausencia de tratamiento antibiótico útil. Se ha planteado que debido a la alta sensibilidad de esta bacteria a los antibióticos beta-lactámicos, muchos casos podrían ser tratados inadvertidamente. Describimos un caso de meningococcemia crónica en una mujer joven que presenta un cuadro clásico no reconocido inicialmente.

Chronic meningococcemia is an unfrequent clinical picture within the spectrum of infections produced by Neisseria meningitidis. It is classically characterized by fever, skin lesions and joint involvement, usually without meningeal involvement, and with blood culture growth of the responsible bacteria. It generally affects previously healthy young people. It is unknown why these patients, unlike patients with Neisseria meningitidis’s acute meningitis and with acute meningococcemia, can survive without complications during weeks, in abscence of an useful antibiotic treatment. It has been hypothesized that owing to high susceptibility to beta-lactam antibiotics of Neisseria meningitidis, many cases may be treated inadvertently. We describe a case of chronic meningococcemia in a young woman who presented a classical clinical picture, not recognized initially.