Cutaneous events during treatment of chronic inflammatory joint disorders with anti-tumour necrosis factor alpha: a cross-sectional study.

BACKGROUND: Anti-tumour necrosis factors (anti-TNF) are more and more used, but the rate of skin adverse events is not known. OBJECTIVE: The aim was to assess the number of skin infections and other dermatoses in patients treated with anti-TNFalpha. PATIENTS AND METHODS: One hundred eighty-seven patients suffering from rheumatoid arthritis or ankylosing spondylitis underwent a dermatological exam. Patients with anti-TNF were compared with those without this treatment in a prospective transversal study. RESULTS: Among them, 59 patients were treated with anti-TNFalpha and steroids were prescribed in 100 cases. There was no difference in the prevalence of skin infections or eczema or tumours. Skin drug reactions were observed in six patients. Infections by dermatophytes appear very frequent, approaching 70% in both groups. CONCLUSIONS: This study shows that skin infections (or other skin diseases) are not more frequent in these patients. No differences were observed in infections (bacterial fungal, parasital or viral), tumours, psoriasis or the manifestations of atopic dermatitis. Nonetheless, a long-term survey might be interesting, especially about skin tumours.

[Late epilepsy in cerebral cysticercosis. 2 cases confirmed by tomodensitometry]. / Epilepsie tardive de la cysticercose cérébrale. Deux cas affirmés par tomodensitométrie.

Invasion of the central nervous system by the larvae of Tenia Solium classically leads to severe illness. In some instances, however, the course is protracted and benign. The authors report on two patients with cysticercosis cerebri, revealed by delayed seizures without cerebral hypertension or any other manifestation. Computerized tomography established the diagnosis by demonstrating calcifications disseminated throughout the cerebral parenchyma. Such calcifications result from encapsulation of dead larvae. The possible diversity of the anatomic lesions caused directly or indirectly by the parasite explains why clinical manifestations are polymorphic. Diagnostic procedures are discussed.

[Bacterial endocardiitis complicating fibroplastic endocarditis: a case report (author's transl)]. / Une observation d'endocardite bactérienne compliquant une endocardite fibroplastique.

A young Protugese man, who had never travelled outside of Europe, was found to have a bacterial complication of a fibroplastic endocarditis. The onset was by a spontaneous chest pain, associated with a posterolatero-apical subepicardial ischemia and giant T waves in V3, V4, and calcification in the apex of the heart on radiography. Diagnosis was confirmed by intracardiac explorations: ventricular telediastolic pressures were increased; the lower border of the right ventricle was smooth, the left ventricle had a globular appearance with a smooth anterior border, the apex appearing to be completely excluded; coronarography was normal. Histological examination confirmed the presence of fibrosis. Anticoagulant treatment was started. Four months after the onset of the disease, a high fever, an apical systolic murmur, and nine positive blood cultures for a streptococcus mitis, suggested the development of a bacterial endocarditis, though no direct evidence was discovered. Improvement occurred after appropriate antibiotic therapy, and the anticoagulants were continued. Cardiac ultrasonography recordings were normal following this episode. This case-report is of two-fold interest: on the one hand it represents an early form of fibroplastic endocarditis, diagnosed by intracardiac exploration, and on the other hand it emphasizes the rare nature of bacterial complications of this affection. Authors differ in their evaluation of the frequency of chest pain, but their inaugural and isolated nature are rarely described. In most cases the presence of the disease is revealed by a progressive cardiac insufficiency. A very positive factor is the presence of calcifications, and the absence of an eosinophilia does not exclude the diagnosis. Electrical anomalies of the ischemic type are possible, but are rarely isolated findings, and the giant appearance of the T waves in this case is rather atypical. Bacterial complications are rare, and are only reported in 12 of the 218 cases described in the published literature. They are rarely diagnosed during the life of the patient (1 case only). The infection affects the cords, the valves, the thrombus, or the fibrosis itself.

[Hepatic syphillis with amyloïdosis and chronic diarrhea. A discussion of etiologic mechanisms (author's transl)]. / Syphilis hépatique, amylose et diarrhée chronique. Discussion étiologique.

A sixty-four year-old woman was admitted for chronic diarrhea with severe weight loss. Investigations showed hepatomegaly, positive serologic tests for syphilis, and nephrotic syndrome with proteinuria. Anasarca occurred and the patient died shortly after admission. Necropsy showed sclero-gummatous hepatic syphilis, generalized amyloïdosis and ulcerative colitis. These last two manifestations and their association with tertiary stage syphilis are discussed.