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Biomedical subjects

J Chevrant-Breton

Publications and source records attributed to J Chevrant-Breton.

10 recordsLinked to original sources

[Cutaneous manifestations observed during prolonged intravenous feeding: 3 cases. Review of the literature (author's transl)].

3 patients (one infant and two adults) in prolonged intravenous feeding for digestive diseases developed cutaneous symptoms resembling acrodermatitis enteropathica. Essential fatty acid and hypozincemia (in 2 of 3 cases) are found. The dermatitis disappeared slowly with oral alimentation in 2 cases, and in a few days in the third one, with oral zinc sulfate. Review of literature shows that dermatitis occurring during prolonged intravenous feeding is attributed to essential fatty acid, zinc, or less often amino acid, deficiency. But resemblance of dermatitis with acrodermatitis enteropathica in most cases, high frequency of hypozincemia, and dramatic effects of treatment with zinc salts allow to think, that zinc is a key factor. Nevertheless, it is necessary to study simultaneously those different parameters and also vitamins A, E and B to conclude whether it exists or not many deficiencies (related or not) as an etiologic factor for cutaneous symptoms.

Acrodermatitis

[Adult Letterer-Siwe's disease. Review of literature (author's transl)].

Letterer-Siwe syndrome is usually encountered in children. It very rarely occurs in adults. 23 cases are found in the literature and analyzed: clinical signs are the same as in infantile observations. Prognosis in some cases is surprisingly very good when only the skin is involved.

Adolescent

[Multicentric reticulo-histiocytosis; review of recent literature (since 1969)].

The review of recent literature (since 1969) shows 35 cases of multicentric reticulo-histiocytosis. This entity was first described as a dermatological disease, then as a dermatoarthritis. It is in fact a systemic disease which can involve many organs but is sometimes monosymptomatic. Its fatal outcome is, sometimes, the result of a disseminated neoplasia or a lymphoma. Its clinical and microscopic features allow to distinguish it from solitary reticulo-histiocytoma, generalized eruptive histiocytoma, congenital reticulo-histiocytosis of Hashimoto and Pritzker and familial histiocytic dermato-arthritis of Zayid.

Diagnosis, Differential

[Shulman's syndrome: fasciitis with eosinophilia, pseudoscleroderma with eosinophilia].

The authors report two cases of the Shulman's syndrome. Twenty one cases of this new entity are found in the literature. The main signs are the acute painful onset after an unusual physical exertion, the development of fasciitis, and (or) myositis, and (or) scleroderma of limbs, the absence of Raynaud's phenomenon, visceral involvement, constant eosinophilia and hypergammaglobulinemia; the prognosis is good with an improvement sometimes spontaneous or coincident with prednisone therapy. One of the observations is interesting by the association with Gougerot-Sjogren's syndrome, and a familial case of morphea. The prognosis in this case is mediocre: failure of corticotherapy, and incomplete remission with cyclophosphamide.

Eosinophilia

[Sarcoidosis with extensive ulcerating and atrophying cutaneous manifestations (of the Pick-Herxheimer type) and with cardiac and muscular involvement. About one case (author's transl)].

The authors report an unusual case of chronic sarcoidosis with skin ulcerations and atrophic lesions simulating Pick-Herxheimer's disease. Other severe manifestations are found: cardiac involvement with conduction disturbances and myocardial failure, and muscular involvement which responded well to corticosteroid therapy.

Arrhythmias, Cardiac

Cutaneous manifestations of idiopathic hemochromatosis. Study of 100 cases.

Skin manifestations of idiopathic hemochromatosis (IH) are presented in 100 cases with emphasis on the previously unrecognized high frequency of ichthyosis-like states and koilonychia. In 50 cases with treated and nontreated groups, histological siderosis and clinical skin pigmentation were found to decrease postphlebotomy whereas melanosis, histologically, did not. By skin biopsy in 50 cases versus controls, the location of siderosis in eccrine sweat glands seems specific for IH providing a strong basis for a probable diagnosis of the disease. There are correlations between skin manifestations and other signs of the disease.

Adult

[Hyperacute periarteritis nodosa complicating Basedow's disease].

The symptoms and the evolution of necrotizing vasculitis vary greatly. The authors illustrate the case of an 18 year old patient with a history of frequent allergic manifestations (urticaria and others) who was found to have, in septembre 1975, a typical case of Grave's disease. During the following 2 months she was treated with an iodide derivative. One year later the clinical signs increased to the point where a treatment associating lugol, carbamizole and propanolol was deemed necessary. Less than 2 months later there developed a polyvisceral disease with oscillating fever, polyarthralgia and necrotizing vasculitis. The plurivisceral nature of the illness was further illustrated by the presence of a hyperreflexia, a glomerulopathy and retinal exsudats. A muscle biopsy revealed the necrotizing vasculitis with granulomas typical of periarteritis nodosa. Cardiac, neurologic and renal complications were responsable for a rapid down-hill course and despite corticoïdes and immunosuppresive drugs, the patient died after a few weeks of treatment. That periarteritis nodosa should complicate the evolution of Grave's disease suggests a connection between the two, very probably immunologic in nature. The role of drugs capable of inducing vasculitis must be explored, especially the iodide derivatives, the antithyroïd medications or their association. Such cases, even though they may be rare, should incite special care in the prescription of antithyroïd drugs in the allergic patient.

Acute Disease