[Acitretin-induced capillary leak syndrome: Case report and literature review]. / Syndrome de fuite capillaire observé sous acitrétine : un cas et revue de la littérature.

BACKGROUND: Retinoids are widely used in dermatology. Adverse effects are frequent and require clinical and laboratory monitoring. Herein we report the case of a patient with secondary capillary leak syndrome (SCLS) associated with acitretin. We then present a review of the literature on systemic retinoids and SFCS. PATIENTS AND METHODS: A 57-year-old patient consulted following the onset of severe type I pityriasis rubra pilaris. Treatment was initiated comprising topical corticosteroids combined with acitretin at a dose of 0.5mg/kg/day. On the eighth day, voluminous edema appeared, accompanied by weight gain of 8kg in 48h and hypotension. The laboratory assessment showed hypoalbuminemia and hemoconcentration. Acitretin-induced SCLS was diagnosed based on the triple signs of hemoconcentration, hypoalbuminemia and hypotension, as well as rapid improvement following discontinuation of acitretin. DISCUSSION: We collected 7 published clinical cases between 1981 and 2018, including our own case report. Retinoids were indicated only in severe cutaneous diseases. The mean time to onset of SLCS is 9.8 days, with a return to normal 17 days after discontinuation of retinoids. Capillary leak syndrome is a rare and under-diagnosed clinical-laboratory syndrome that must be recognized in order to avoid potentially fatal inappropriate management. It is a rare adverse effect of retinoids used in dermatology and the pathophysiology remains unclear.

Clinical and immunological features and outcome of anti-p200 pemphigoid.

BACKGROUND: Anti-p200 pemphigoid is a rare autoimmune blistering disease (AIBD) of the dermoepidermal junction, characterized by autoantibodies to laminin γ1. The clinical course of anti-p200 pemphigoid in patients remains poorly investigated. OBJECTIVES: We aimed to describe the clinical and immunological features and the course of a series of patients with anti-p200 pemphigoid. METHODS: We conducted a retrospective study by immunoblotting detection of sera on 200-kDa dermal protein extracts from the register of the French reference centre for AIBD. We recorded the clinical and immunological features and the course of patients. RESULTS: A total of 14 patients with a mean age 81·6 ± 6·5 years were included. Only one patient had an associated neurological condition and one had psoriasis. Twelve patients had atypical clinical presentation, including eczematous, urticarial, prurigo-like, dyshydrosis-like and rosette-like skin lesions. Eight patients (57%) had mucosal involvement. Immunoblot analysis of sera on dermal and epidermal extracts showed a 200-kDa band in 14 and 10 cases, respectively. All eight of the sera tested by enzyme-linked immunosorbent assay detected recombinant human laminin γ1. Disease control was obtained in six of nine patients treated with topical corticosteroids, and four of five patients who received systemic treatment. Seven patients relapsed (50%) and five patients (36%) died during the median follow-up time of 12·6 months. At the end of the study, only one of the nine living patients was in complete remission off therapy. CONCLUSIONS: Many patients with anti-p200 pemphigoid had heterogeneous clinical presentation and a more severe prognosis than previously suspected.

Vemurafenib skin phototoxicity is indirectly linked to ultraviolet A minimal erythema dose decrease.

BACKGROUND: Vemurafenib, an anti-rapidly accelerated fibrosarcoma kinase B (BRAF) molecule, improves survival among patients with metastatic BRAF-mutated melanoma. Photosensitivity, a frequent cutaneous adverse effect induced by vemurafenib, can lead to cessation of treatment. OBJECTIVES: To investigate photosensitivity mechanisms in patients treated with vemurafenib for metastatic melanoma. METHODS: In a prospective study of 12 patients, photobiological explorations with measurements of ultraviolet A (UVA) minimal erythema dose (MED) and polychromatic MED were performed over 3 days in all 12 patients. UVA MED and polychromatic MED were also assessed for four patients before treatment. We then performed spectrophotometric analyses of (i) serum and faeces in these four patients, before and after introduction of vemurafenib; (ii) the lyophilized form of vemurafenib without excipient added; and (iii) the lyophilized form of vemurafenib added to serum and faeces before treatment. RESULTS: Photosensitivity was present in 92% of the patients. UVA MED was normal before treatment and decreased after treatment, while polychromatic MED remained normal. The same three peaks (210, 260 and 310 nm) were identified in the spectrum for UVB and UVC but not for UVA on spectrophotometric analyses for each condition (lyophilized vemurafenib; serum and faeces after introduction of vemurafenib; and lyophilized vemurafenib added to serum and faeces before treatment). The peaks were different before treatment. CONCLUSIONS: Our study confirms that photosensitivity under vemurafenib treatment was a UVA phototoxicity reaction, and our results suggest that a metabolite of vemurafenib rather than the parent molecule is involved in this phototoxicity.

[An atypical form of Kimura's disease]. / Un cas de maladie de Kimura dans une forme atypique.

BACKGROUND: Kimura's disease is a rare benign chronic inflammatory disease of unknown aetiology. CASE REPORT: An 18-year-old atopic Brazilian patient consulted for recurrent facial eczema that improved slightly under topical corticosteroids. He presented a large infiltrated and eczematous subcutaneous plaque on the right supraorbital area, together with eyelid oedema. This was associated with complete right eyebrow alopecia, oedema of the upper lip and infiltrated facial papules. The tests showed hypereosinophilia (4000/mm(3)), a high IgE level (3786 kIU/L) and proteinuria (0.3g/24h). Histological examination revealed a lymphocytic eosinophil-rich inflammatory infiltrate in the superficial and deep dermis, with some lymphoid follicles in depth and proliferation of post-capillary venules. All of these elements led to the diagnosis of Kimura's disease. DISCUSSION: We report an unusual clinical form of Kimura's disease in a Brazilian patient. This disease has been classically described in young Asian men. In our case, a particularly large infiltrated and oedematous subcutaneous plaque was noted. In fact, the more common forms appear as subcutaneous nodules on the head and neck, which may be associated with locoregional adenopathy, involvement of the salivary glands, hypereosinophilia and raised serum IgE. In our case, the skin lesions, characterized by a large infiltrated and oedematous subcutaneous plaque, were unusual and could evoke IgG4-related disease. CONCLUSION: We report a case of Kimura's disease with an atypical presentation. The diagnosis was established by comparing certain histopathological features, and the possibility of IgG4-related disease was discussed.

[Infantile bullous pemphigoid]. / Pemphigoïde bulleuse du nourrisson.

BACKGROUND: Bullous pemphigoid (BP) is a form of autoimmune bullous disease commonly seen in adults but rare amongst children. Only a few cases have been described in children after vaccination. This article reports a new case of BP that occurred in an infant after a first vaccination. PATIENTS AND METHODS: A 3-month-old girl presented a bullous eruption 2 weeks after a first injection of Infanrix Quinta(®) and Prevenar(®). The eruption began on her palms and soles. It was associated with urticaria-like lesions on her thighs, chest and abdomen. A histological skin examination and direct immunofluorescence showed dermal-epidermal cleavage and IgG and C3 deposits in the epidermal basement membrane zone, which are typical features of BP. No antibodies against basement membrane were seen. Clinical remission was observed after 5 weeks of treatment with dermal-corticosteroids. Resumption of the vaccination schedule did not induce any recurrence of the disease. DISCUSSION: The clinical presentation of BP amongst children differs from that seen in adults, notably in terms of the predominance of palmoplantar lesions in children aged less than 1 year. In addition, lesions on mucous membrane are more frequently reported amongst older children. Histological findings are similar in all age groups. The outbreak of BP due to a vaccinal antigen appears hypothetical. However, continuation of the vaccination schedule did not induce any recurrence. Moreover, it is a rare disease amongst children despite the frequency of vaccinations in this population. CONCLUSION: Childhood BP is a diagnosis that should be considered in any case of bullous eruption, in particular if the palms and soles are affected. It is a benign disease that resolves in less than a year under treatment. The current data do not incriminate vaccines in the outbreak of childhood BP and suggest that continuation of vaccination is not contraindicated.

Pseudo-spin skyrmions in the phase diagram of cuprate superconductors.

Topological states of matter are at the root of some of the most fascinating phenomena in condensed matter physics. Here we argue that skyrmions in the pseudo-spin space related to an emerging SU(2) symmetry enlighten many mysterious properties of the pseudogap phase in under-doped cuprates. We detail the role of the SU(2) symmetry in controlling the phase diagram of the cuprates, in particular how a cascade of phase transitions explains the arising of the pseudogap, superconducting and charge modulation phases seen at low temperature. We specify the structure of the charge modulations inside the vortex core below T c, as well as in a wide temperature region above T c, which is a signature of the skyrmion topological structure. We argue that the underlying SU(2) symmetry is the main structure controlling the emergent complexity of excitations at the pseudogap scale T *. The theory yields a gapping of a large part of the anti-nodal region of the Brillouin zone, along with q = 0 phase transitions, of both nematic and loop currents characters.

[Food allergy in the child: an exploratory study on the impact of the elimination diet on food neophobia]. / Impact du régime d'éviction sur la néophobie dans le cadre d'une allergie alimentaire chez l'enfant : étude exploratoire.

OBJECTIVES: This study was designed to analyse the impact of an elimination diet in children with food allergy, and its perception by their parents on the later reticence of children to test unknown foods, food neophobia. METHODS: The degree of food neophobia of children having outgrown their allergy (mean age, 7 years 2 months) was compared to that of a sibling (9 years 5 months) using a standardized scale and a questionnaire of food friendliness. Parents were also asked to fill in a questionnaire on the disease and its burden on the family. RESULTS: Children having outgrown their allergy are more reluctant to test new foods than their non-allergic brother or sister, as shown by their scoring on the food neophobia scale and the number of unknown foods following the cure of the disease. Two factors increase the level of food neophobia, the distressing effect and the duration of the period elapsed until the diagnosis was made, as well as the distressing effect and the lack of variety in the meal preparation. CONCLUSION: Food neophobia, a normal phase between 2 and 10 years, is worsened by the elimination diet required by food allergy, especially in case of late diagnosis and when the time elapsed before diagnosis and the preparation of meals were perceived as difficult to bear.

Specific photoaffinity labelling of a ferripyoverdin outer membrane receptor of Pseudomonas aeruginosa.

In order to identify and characterize the receptors involved in pyoverdin-mediated iron transport in Pseudomonas aeruginosa ATCC 15692, a photoactivatable siderophore has been synthesized. In the dark, this probe is stable and is able to promote iron transport at the same rate as the native pyoverdin. Under irradiation at 312 nm, the molecule is photodecomposed and a clear inhibition of the iron transport is observed. With the radioactive form of this photoactivatable probe, we were able to visualize on a SDS-PAGE gel a labelled protein of approximately 90 kDa molecular mass, which is very likely the FpvA receptor or a yet unknown pyoverdin receptor.

Shape-based interpolation of tree-like structures in three-dimensional images.

Many three-dimensional (3-D) medical images have lower resolution in the z direction than in the x or y directions. Before extracting and displaying objects in such images, an interpolated 3-D gray-scale image is usually generated via a technique such as linear interpolation to fill in the missing slices. Unfortunately, when objects are extracted and displayed from the interpolated image, they often exhibit a blocky and generally unsatisfactory appearance, a problem that is particularly acute for thin treelike structures such as the coronary arteries. Two methods for shape-based interpolation that offer an improvement to linear interpolation are presented. In shape-based interpolation, the object of interest is first segmented (extracted) from the initial 3-D image to produce a low-z-resolution binary-valued image, and the segmented image is interpolated to produce a high-resolution binary-valued 3-D image. The first method incorporates geometrical constraints and takes as input a segmented version of the original 3-D image. The second method builds on the first in that it also uses the original gray-scale image as a second input. Tests with 3-D images of the coronary arterial tree demonstrate the efficacy of the methods.

Multifocal aggressive squamous cell carcinomas induced by prolonged voriconazole therapy: a case report.

Voriconazole is a treatment for severe fungal infections. Prolonged voriconazole therapy may induce skin reactions, with 1% of severe photosensitivity accidents. Recently the imputability of voriconazole in skin carcinogenesis has been suggested. This report concerns a 55-year-old man suffering from pulmonary aspergillosis who presented a phototoxic reaction a few months after introduction of voriconazole, followed by multiple squamous cell carcinomas of sun-exposed skin areas. After voriconazole discontinuation, no new carcinoma was observed. The detection of EBV and HPV in skin lesions was negative. Exploration of gene mutations involved in skin carcinogenesis showed two variants of the MICR gene. The occurrence of multiple, recurrent, aggressive squamous cell carcinomas is rare with voriconazole, but its imputability is strongly suggested. A plausible hypothesis is that several factors including voriconazole uptake, immunosuppression, and genetic background could explain the phenotype of fast-developing skin carcinomas. Voriconazole therapy should be accompanied by stringent photoprotection and skin monitoring.

Phosphorylation by PKA of a site unique to B-Raf kinase.

The Raf kinases serve as central intermediates to relay signals from Ras to ERK. Cell-specific effects of these signals on growth, differentiation and survival can be observed due to the recruitment of different isoenzymes of the Raf family. The in vitro phosphorylation of a site unique to B-Raf (Ser429) has been proposed to be responsible for the negative regulation of the isoenzyme by Akt. Using phosphopetide mapping and site-directed mutagenesis we showed that Ser429 is phosphorylated upon cAMP elevation in PC12 cells and proposed that PKA is a major kinase phosphorylating the B-Raf-specific site in vivo.

Raf-1 and B-Raf proteins have similar regional distributions but differential subcellular localization in adult rat brain.

The Raf kinases play an important and specific role in the activation of extracellular signal-regulated kinases (ERK) cascade. Beside its role in the control of proliferation and differentiation, the ERK cascade has also been implicated in neuron-specific functions. In order to gain clues on the function of Raf kinases in the adult central nervous system (CNS), we performed a comparative analysis of the distribution and subcellular localization of the different Raf kinases in rat brain with antibodies specific for the different Raf kinases. We show that B-Raf and Raf-1 proteins are present in most brain areas, whereas A-Raf is not detected. Interestingly, the two Raf proteins have an approximately similar pattern of distribution with a rostro-caudal decreasing gradient of expression. These two kinases are colocalized in neurons but they are differentially located in subcellular compartments. Raf-1 is localized mainly in the cytosolic fraction around the nucleus, whereas B-Raf is widely distributed in the cell bodies and in the neuritic processes. In addition, we demonstrated that numerous B-Raf isoforms are present in the brain. These isoforms have a differential pattern of distribution, some of them being ubiquitously expressed whereas others are localized to specific brain areas. These isoforms also have a clear differential subcellular localization, specially in Triton-insoluble fractions, but also in synaptosomal, membrane and cytosolic compartments. Altogether these results suggest that each Raf protein could have a distinct signalling regulatory function in the brain with regard to its subcellular localization.