[Diffused ulcerated cutaneous sarcoidosis occurring on top of scars]. / Sarcoïdose cutanée ulcérée et diffuse survenant sur cicatrices.

INTRODUCTION: Sarcoidosis in patients of African or Afro-Caribbean origin presents semiological characteristics, together with polymorphic skin lesions, more extensive forms and a poorer prognosis. Ulcerated and particularly diffuse skin forms are very rare. Herein we report a case of diffuse ulcerated skin sarcoidosis appearing on top of old scars in a female patient of Afro-Caribbean origin. PATIENTS AND METHODS: A 16-year-old Caribbean girl consulted for multiple painful papules that appeared on old burns scars. The skin biopsy was consistent with sarcoidosis. At the same time, the patient developed sarcoid uveitis, and sarcoid dactylitis was suspected. Shortly thereafter, painful and diffuse ulcerations appeared on pre-existing skin lesions. Systemic corticosteroid therapy resulted in clinical improvement, but corticosteroid-dependency warranted subsequent initiation of methotrexate. DISCUSSION: Ulcerated cutaneous forms of sarcoidosis are rare and are often associated with severe forms, and they should prompt screening for systemic damage. There do not appear to be any previous reports of the presentation of ulcerated and extensive skin sarcoidosis presenting on scars, as described in the present study.

[Contraception in women suffering from systemic lupus ethymatosus]. / La contraception chez les femmes atteintes de lupus erythemateux dissemine.

PIP: Systemic lupus erythematosus usually affects young women of reproductive age and may be brought on or worsened by pregnancy or use of some oral contraceptives (OCs). At certain stages of the disease pregnancies are possible, but effective and reversible contraception permitting careful pregnancy planning is required. Amenorrhea is frequent in acute stages of the disease, but most authors have observed fertility levels in lupic women comparable to those of the population at large. Pregnancy complications and aggravations of lupus are much more rare when conception occurs during a stable remission of at least 6 months. Risks of lupus that must be considered in choosing a contraceptive method include vascular accidents such as venous thrombosis and inflammatory lesions of the arteries, hypertension usually secondary to nephropathy or corticotherapy, metabolic disturbances, anomalies of hemostasis, initiation or exacerbation of the disease with use of combined OCs, and predisposition to infection. Pills containing estrogen, even at low doses, are contraindicated because of the already high vascular risk of lupus patients and because estrogens may aggravate the condition. Progestins derived from 19 norsteroids are inadvisable because of the still imperfectly understood secondary effects which may include disturbances of metabolism or blood pressure. Low dose progestins or those derived from 17 hydroxyprogesterone appear to be a contraceptive of choice for lupus patients because of their lack of effects on metabolism or blood pressure. Their contraceptive efficacy is not quite as high as that of other OCs and they may entail a relative hyperestrogenic climate. They are not advisable in case of luteal insufficiency. IUDs are contraindicated because of the risk of infection, although they may be used in periods of remission for mild cases of lupus not treated with immunosuppressive drugs. Progestin-releasing IUDs may reduce risk of infection. Local methods have the advantage of being innocuous but their relatively high failure rate makes them inappropriate except for highly motivated women in stages of remission.^ieng

Corticosteroid-responsive pure red cell aplasia in chronic lymphatic leukemia.

Acquired pure red cell aplasia characterized by selective failure of erythropoiesis was seen in a 37-yr-old female patient with a diagnosis of chronic lymphatic leukemia (CLL). Though different immunosuppressive therapies have been tried in the past with variable response, there has been no case report of such favorable response to corticosteroids alone. We report this rare and unusual case of PRCA associated with CLL who responded to steroid therapy.