["Milia en plaque" with multiple and successive localizations].
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Biomedical subjects
Publications and source records attributed to T Le Guyadec.
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BACKGROUND: Cutaneous reactions may occur in patients receiving terbinafine therapy, mainly rash and urticaria. More exceptionally, development of psoriasis has been described. We describe the development of plantar pustular psoriasis in a patient who took oral terbinafine. CASE REPORT: A 70-year-old man, without previously known history of psoriasis, was treated with terbinafine, 250 mg/day, for onychomycosis. Ten days later, a plantar pustular psoriasis appeared. The psoriasis cleared up after discontinuation of terbinafine and institution of antipsoriatic therapy. DISCUSSION: Terbinafine is an antifungal agent widely use in the treatment of onychomycosis. A skin reaction occurs in 3 p. 100 of patients. Only 24 cases of flare-up of previous psoriasis or psoriasis de novo after terbinafine have been described. The psoriasis generally clears after discontinuation of terbinafine. So, terbinafine is perhaps not the best first line therapy for onychomycosis in patients with psoriasis.
We report a case of lobomycosis presenting like a cutaneous tumoral lesion in a patient living in Guyana. The causative agent is Loboa loboi. The illness is seldom observed in metropolitan France. The epidemiology, the clinical features, the course and the treatment are studied. The diagnosis is histological, with the morphological features of yeast-like cells.
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BACKGROUND: Segmental neurofibromatosis (NF V) is ten times less frequent than Recklinghausen disease. Would the risk of visceral involvement in this uncommon form of neurofibromatosis warrant systematic imaging procedures? CASE REPORT: A 31-year-old man consulted for a voluminous plexiform neurofibroma in the left lumbar area. More ventrally, on the left side, there was also a café au lait spot. There were no Lisch nodules. The chest and abdominopelvic computed tomography and magnetic resonance imaging showed intramuscular tumoral extension, two neurofibromas in the 9th intercostal space and a voluminous 5-cm tumor situated in the left adrenal area. After resection pathology examination of the surgical specimen confirmed the diagnosis of ganglioneuroma. DISCUSSION: In this patient, all the neurofibromas and the café of lait spot developed in the territories of the left T10 and adjacent spinal roots. This was also true for the ganglioneuroma which developed on the deep sympathetic ramus to the adrenal gland which originates essentially from roots T8 to T11. This would place this case in the second subgroup of NF V in Roth's classification. Only six other cases have been reported in the literature. Such deep localizations are very likely to be underestimated, raising the problem of their detection and the correct protocol to follow asymptomatic forms, especially to detect disease progression to malignant degeneration which has a poor prognosis. Patients with a NF V should receive genetic counselling with a search for a family history, other signs of neurofibromatosis and Lisch nodules. In young patients, the risk of deep asymptomatic spread underlines the importance of regional computed tomographic or magnetic resonance explorations.
BACKGROUND: Trichodiscoma is an uncommon benign tumor of the pilosebaceous system. CASE REPORT: An 83-year-old man had a past history of adenomatous polyps of the colon. The subject's brother had died from cancer of the colon. Over the past 4 years, the patient had developed approximately 30 small asymptomatic papulonodular tumors on the trunk. Skin biopsy demonstrated trichodiscomas. DISCUSSION: Together with fibrofolliculomas and perifollicular fibromas, trichodiscomas are benign tumors of the pilosebaceous system. These different tumors may occur simultaneously as in Birt-Hogg-Dubé syndrome which associates trichodiscoma and familial colonic polyposis. This combination has only been reported in Birt-Hogg-Dubé syndrome or with perifollicular fibromas. CONCLUSION: This case suggests that patients with hamartomas of the pilosebaceous system should undergo explorations in search for digestive tract polyposis.
We report a case of a 73 year old man presented a spontaneously and completely regression cutaneous malignant melanoma with cervical lymph node metastasis, confirmed by clinical and histopathologic observations. The authors examine the features of regression of primary malignant melanoma through a review of the literature.
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INTRODUCTION: We report five cases of pigmented erythroderma occurring during AIDS, noteworthy for its unusual hyperpigmented feature, its advent at the terminal stages of AIDS, and an CD8 cells dermal infiltrate. PATIENTS AND METHODS: It is a retrospective study of five patients infected with HIV: a woman infected by transfusion and four homosexual men, average 55 years old. No one was intravenous drug user. They were all severely immunocompromised; HTLV I/II serology was negative. Skin biopsies were studied with light microscopy (Hematoxylin-eosin) and immunohistochemical studies were performed on frozen sections. RESULTS: The patients had an erythroderma of particular interest because of the associated hyperpigmentation, the severe repercussion (pruritus, weight loss), and the difficulty in treating (except systemic corticosteroids). The histology demonstrated a mononuclear dermal lymphocytic infiltrate, without epidermotropism and atypical cytonuclear feature. The phenotype of the infiltrate was uniformly of the suppressor-cytotoxic subset (CD8+, CD4-). COMMENTS: Our cases are like those previously described as "Pseudo-Sezary", mimicking a lymphoma during AIDS. Numerous factors are probably the cause of this hyperpigmented erythroderma: HIV, CD8 cells... CONCLUSIONS: This severe skin disease, complicating AIDS, seems very particular, but not yet clearly defined. In practice, the problem remains the treatment of this severe erythroderma, because only the systemic corticosteroids are effective, but this is debatable during the treatment of AIDS.
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Gynecomastia, a very frequent disorder, is present in almost 40% of young men. In this population the investigations often fail to find any aetiology, therefore defining idiopathic gynecomastia. The aim of this work is to compare clinical and hormonal characteristics of 488 subjects with gynecomastia to 41 healthy controls. Their are many explanations for the occurrence of idiopathic gynecomastia, including modification of hormonal balance, change of aromatase activity, or a receptor anomaly. Our works demonstrate a significant decrease in mean testosteronemia, linked to a high prevalence of incipient hypogonadism in the studied population, especially in patients with an history of testicular disease.
A prospective study during 28 months at the Regional Hospital Center of Bouake (Ivory Coast) allows to gather 124 cases of Buruli ulcer. Today, this atypical cutaneous mycobacteriosis is in full expansion in West Africa. The pathogen agent, Mycobacterium ulcerans, causes, by its toxin, a subcutaneous necrosis often extended, followed by an ulceration which clinical characteristics are sufficient for the diagnostic. The endemic progression reason may not be caused by the modification of patients receptivity, but rather by the natural environment modification. In particular, the improving number of some soft water fish (Tilapia) which could have a germ tank.
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