[Clinical and histological features of cutaneous drug reactions]. / Aspects anatomo-cliniques des atteintes cutanées médicamenteuses.

Over the last 20 years, our understanding of cutaneous adverse drug reactions has improved, especially with regard to the management of affected patients. The pathophysiological mechanisms have been studied to improve our understanding. We report different clinical and histological features of cutaneous drug reactions to distinguish a non drug-induced rash from a cutaneous adverse drug reaction.

[Umbilical cutaneous metastasis (or Sister Mary Joseph's nodule) disclosing an ovarian adenocarcinoma]. / Métastase cutanée ombilicale (ou nodule de Soeur Mary Joseph) révélatrice d'un adénocarcinome ovarien.

In this study, the case is described of an umbilical metastasis as the presenting symptom of an ovarian adenosarcoma. The overall frequency of cutaneous metastases has been estimated at between 5 and 9%. Umbilical metastases are a rare occurrence: it is estimated that between 1 and 3% of patients with abdomino-pelvic disease present with an umbilical nodule. Epidemiological studies have shown the female predominance of this disease. The clinical characteristics of umbilical metastases cannot be visually distinguished from those of primary lesions. The clinical appearance is often that of a nodule of varying size, more or less painful, and sometimes ulcerated or suppurating as in the present case. The nodule may be indicative of cancer, or of cancer recurrence. The most frequently encountered histological type is adenocarcinoma (about 75% of cases), and is more rarely epidermoid, undifferentiated, or carcinoid. Etiological findings have indicated a digestive origin in over 55% of cases (stomach, colon, rectum, pancreas, in decreasing order of frequency), with a clear male predominance; cancers of gynecological origin are the second most frequent etiology, with ovarian cancers being the most common (34% of cases). Sister Mary Joseph nodule accounts for 60% of all malignant umbilical tumors (primary or secondary), and is usually associated with a poor prognosis (mean survival: 10-12 months). However, patient survival time could be lengthened by aggressive therapy, i.e., surgery combined with chemotherapy.

[Cutaneous manifestations of Yersinia enterocolitica infection]. / Manifestations cutanées d'une infection à Yersinia enterocolitica.

BACKGROUND: Cutaneous manifestations occurring in infections due to Yersinia enterocolitica are usually erythema nodosum, erythema multiforme or cutaneous vasculitis. The association between Yersinia infection and Sweet's syndrome is rare. We describe such a case contributing to the discussion on this association. CASE-REPORT: A 29-year-old woman had a papulo-pustular eruption with fever associated with arthralgia. The results of the infectious laboratory investigations were negative but Yersinia enterocolitica type 0.9 was isolated from a stool culture. The serologic diagnosis of Yersinia enterocolitica using serum agglutinins was negative. The diagnosis of Sweet's syndrome was made on a skin biopsy specimen. Search for hematology disease or underlying neoplasia was negative. The clinical course was rapidly favorable with antibiotic treatment (ciprofloxacin). DISCUSSION: The diagnosis of Yersinia enterocolitica infection is difficult. Microbiologic diagnosis of Yersinia infection is best achieved by isolation of the bacterium from a clinical specimen of involved tissue. The agglutination test is not highly specific or sensitive. Immunoblotting appears to be more sensitive.

[Imatinib-induced purpuric vasculitis]. / Vasculite purpurique induite par l'imatinib.

INTRODUCTION: Imatinib (Glivec) is a new molecule that specifically inhibits tyrosine-kinase activity and is used in the treatment of chronic myeloid leukemia. Cutaneous side effects with imatinib are frequent. We report the first case of purpuric vasculitis probably due to this drug. OBSERVATION: A 65 year-old man was treated for chronic myeloid leukemia with imatinib. After two months of treatment, he developed an erythematous and squamatous on the trunk, which regressed spontaneously one week after suspension of the product. Imatinib was reintroduced two months later. The patient immediately developed a painful, infiltrated, purpuric eruption on the legs. Histological examination revealed vasculitis compatible with the diagnosis of toxiderma. Since treatment could not be suspended, oral corticosteroids were introduced and the lesions cleared within three weeks. DISCUSSION: Adverse cutaneous reactions to imatinib are frequent. Their physiopathological mechanism is unknown.

[Contact dermatitis to topical antiviral drugs]. / Dermites de contact aux antiherpétiques locaux.

BACKGROUND: Topical antiviral drugs are frequently used. Repeated applications on a skin injured by the viral infection can lead to irritating dermatitis or contact eczema. This secondary effect is often unrecognized because imputed to an increase of the initial dermatosis. CASES REPORTS: Case 1 - A 58 year-old woman had an eczema around the mouth after the use of Zovirax(R) cream (acyclovir). The patch test with this cream was positive (++ at 96 h) but the detail of all the constituents was negative. Case 2 - A 39 year-old woman had an eczema surrounding the mouth after each use of Zovirax(R) cream and Cuterpes(R) (ibacitabin). The patch tests were doubtful for Zovirax(R) cream, positive for Cuterpes(R) (++ at 96 h) and ibacitabin 1 p. 100 and 10 p. 100 in petrolatum (++ at 96 h). Case 3 - A 58 year-old man had an acute eczema of the face after the use of Zovirax(R) cream and Vira-MP(R) (vidarabin phosphate). The patch tests were positive for the both antiviral topical drugs but negative for each one of their constituents. DISCUSSION: Contact dermatitis to antiviral topical drugs are rare, due to active molecule or its excipients. The propyleneglycol, component found in the three antiviral drugs, can induce irritation or allergy. In the most of cases, like in our case number 1 and 3, the patch tests with each constituents of the topical drugs were negative, we conclude to a compound allergy.

[Cross-sensitivity between angiotensin-converting enzyme inhibitors and angiotensin II receptor antagonist]. / Toxidermies aux inhibiteurs de l'enzyme de conversion pérennisées par la prise d'inhibiteurs de l'angiotensine II.

BACKGROUND: Cross-sensitivity between angiotensin-converting enzyme inhibitor-induced angioedema and cough, and angiotensin II receptor antagonist has been reported in the literature. Eczema-like skin reactions have never been documented. We report the first two cases. CASE REPORTS: Two patients, aged 79 and 88 years, with a history of hypertension, were treated with angiotensin-converting enzyme inhibitors, which had been discontinued because of an eczematiform rash. In spite of substitution with an angiotensin II receptor antagonist, the patients had developed the same eruption. The outcome was favourable after discontinuation of the angiotensin II receptor antagonist. The pharmacologic study suggested the possibility of a cross-sensitivity reaction between these two drugs. CONCLUSION: We report the first two cases of a cross-sensitivity between angiotensin-converting enzyme inhibitors and angiotensin II receptor antagonist presenting as an eczematiform rash. The exact mechanism is unknown, but clinicians must be aware that angiotensin II receptor antagonist is not a safe alternative in patients who have a history of eczematiform rash secondary to angiotensin-converting enzyme inhibitors, as has been always reported with angioedema.