[Factitious crusting cheilitis]. / Chéilites squamo-crouteuses factices.

The authors report 4 cases of factitious crusting cheilitis seen in young women. The lesions are crusty, yellowish or even black, forming as a mould casting the lip. The crusts are sometimes very thick just as an oyster-shell. When removed the underlying mucosa appears either normal or erosive and the crusts reappear rapidly. Emotional factors and personality disturbances are often present. Most probably the crusts are the result of a traumatic mechanism induced by chewing or sucking the lip. In the 4 reported patients the clinical aspect and the psychological status of the patients are similar, the 4 of them being not at all bothered by their cheilitis. The factitious keratotic cheilitis has to be differentiated from other cheilitis induced by Candida albicans (although Candida albicans may superinfect any cheilitis) or by an actinic phenomenon, from glandular cheilitis (of the Puente-Acevedo or of the Volkmann type) and from dermatitis localized on the lips. In some instances an exfoliative cheilitis may also to be of factitious origin. The factitious origin of such a cheilitis is always difficult to demonstrate but its possibility should be kept in mind.

[Disseminated actinomycosis presenting with multiple subcutaneous abscesses (author's transl)]. / Actinomycose disséminée à expression cutanée.

The case report describes a patient hospitalized for multiple subcutaneous abscesses who presented a four-year history of recurrent skin lesions and a fifteen-year history of non specific bronchopulmonary infections requiring segmental resection. The diagnosis of actinomycosis, A. israeli species, was established by culture of surgical drainage material from a thoraco-abdominal wall abscess. Muscle and bone involvement of the right thigh was subsequently demonstrated. There was no evidence of pulmonary infection at the time of hospitalization. Treatment with Penicillin G was curative. A review of the literature is presented together with a summary of thirteen reported cases. Although disseminated actinomycosis has become very rare since the introduction of antibiotic therapy, patients share similar features and a common clinical pattern which are highly evocative of the disease. All patients described had preceding pleuropulmonary disease, characteristically chronic. Evolution of cutaneous lesions was subacute or chronic. In all cases, there was significant delay (months to years) between the initial appearance of skin lesions and subsequent diagnosis. In most cases, actinomycosis had not been suspected. Diagnosis was usually established by isolation and identification of the micro-organism in cultures of purulent material obtained from cutaneous lesions. Despite the probability of hematogenous disease dissemination, pleuro-pulmonary foci were only rarely demonstrated. Prolonged antibiotic therapy was curative in all treated cases.

[Histiocytosis X with partial antehypophyseal deficiencies. 2 cases]. / Histiocytose X avec déficits antéhypophysaires partiels. Deux observations.

Diabetes insipidus is the most common endocrine disturbance associated with chronic multifocal form of histiocytosis X. Involvement of the hypothalamus can lead to growth hormone deficiency and short stature in children. Two cases with hypogonadism, growth hormone deficiency and diabetes insipidus are reported. In a 22-year-old man plasma testosterone was low and increased after administration of human chorionic gonadotrophin. Cutaneous and lytic bone lesions disappeared after treatment with Vinblastin. Partial diabetes insipidus was treated with clofibrate. A 59-year-old woman was found to have low pituitary gonadotrophins that failed to rise after administration of gonadotropin-releasing hormone and hyperprolactinemia. Fatal outcome was associated with polyuria, bone, cutaneous, gut and hypothalamic infiltration by histiocytes. There was no direct involvement of the anterior pituitary gland.

[Myelopathy manifesting as macroglobulinemia]. / Myélopathie révélatrice d'une macroglobulinémie.

Slowly progressive cervical cord symptoms over a 2 year period led to the diagnosis of Waldenström macroglobulinemia in a 32 year old man. Diagnosis was made on the finding of circulating monoclonal IgM and lymphocyte infiltration of the bone marrow. Perimedullary infiltration of cervico-dorsal cord was visualized by CT scan. No other tumor tissue was found. Intrathecal secretion of IgM in the CSF was demonstrated. Cervico-dorsal cord radiotherapy followed by systemic chemotherapy led to a rapid improvement in the neurological signs. Reports of spinal cord lesions in Waldenström macroglobulinemia are rare and the relationship of this condition with respect to so-called secreting neurolymphomatosis is discussed.