[Cutaneous granulomatous lesions disclosing ataxia-telangiectasia]. / Lésions granulomateuses cutanées révélatrices d'une ataxie-télangiectasie.

INTRODUCTION: Idiopathic cutaneous granulomatous lesions are exceptionally described in the course of congenital immunodeficiency, including ataxia-telangiectasia. CASE REPORT: We describe a new case of a 28-month girl who presented granulomatous skin lesions revealing a previously unknown ataxia-telangiectasia in the absence of typical neurologic signs, telangiectasia and infectious complications. The clinical aspect showed infiltrated erythemato-squamous plaques and nodules predominating on the face and limbs. These lesions increased in number without remission. Histological examination revealed a nodular, lymphohistiocytic infiltration with granulomatous tendency in the deep dermis and the hypodermis. Before the onset of skin treatment, the child developed an Epstein-Barr-virus related lymphoproliferation. Immunoglobulins and oral corticosteroids associated with chemotherapy permitted the regression of the granulomatous lesions but not of the fatal spread of the lymphoproliferative syndrome. DISCUSSION: These rare cutaneous manifestations are important to know because they can be the initial sign of an immunodeficiency. Clinical and histological aspects are characteristic. They are eventually associated with visceral granulomatous lesions. Physiopathology remains hypothetical. An abnormal immune response to an undetermined antigenic stimulation could be suspected in this particular context. The question of a correlation between these lesions and a proliferative syndrome remains open.

[Lichenoid contact dermatitis from the ink of a red pen]. / Dermite de contact lichénoïde à l'encre rouge d'un stylo.

INTRODUCTION: Numerous cutaneous inflammatory reactions have been reported in literature, after using red dyes; most of them are lichenoid reactions and occur after tattooing. Few reports have mentioned inflammatory complications after using red ink. CASE REPORT: A 21-year-old woman was examined for papular erythematous, pruritic lesions on the back of her left hand. They developed within the area of a red inked pen writing, a few days before. There was an isomorphic reaction on the cheek which was in contact with the hand during sleep. Diagnosis of lichen reaction to red ink was made, and histologically confirmed on the hand. DISCUSSION: We report the first case to our knowledge of lichen reaction to red inked pen, which can be compared to hypersensitivity reactions to red pigment reported in literature. A Koebner phenomenon by friction, usual with lichen, is possible, but doesn't explain the reaction on the cheek. A contact dermatitis to red pigment of ink can also be suggested, although mostly eczema-like reactions have so far been reported; it seems moreover that lichenoid reactions reported only occur after intradermal injection of pigment during tattooing. This contact mechanism would nevertheless explain both localizations of lichen reaction in our patient.

[Palmoplantar filiform parakeratotic hyperkeratosis and digestive adenocarcinoma]. / Hyperkératose palmo-plantaire filiforme parakératosique et adénocarcinome digestif.

INTRODUCTION: There are very few observations of filiform palmo-plantar hyperkeratosis reported. Nevertheless it's worth knowing this entity for his potential association with a visceral neoplasia. CASE REPORT: We report the first case of filiform palmo-plantar hyperkeratosis associated with a digestive adenocarcinoma and a polycystic kidney disease. DISCUSSION: After a review of palmar and plantar filiform hyperkeratosis in the literature, we will discuss the possible association with neoplasia or other pathologies. This pathology requires a strict clinical and paraclinical follow-up.

Erythema multiforme due to pyrazinamide.

Drug-induced erythema multiforme is reported with many antimicrobial and antipyretic medications. We present one patient who experienced erythema multiforme and urticaria after administration of pyrazinamide for treatment of cutaneous tuberculosis. The side-effects of pyrazinamide include hepatic or dermatologic disorders, but erythema multiforme has not yet, to our knowledge, been described. Clinical features and discontinuation and reintroduction of the drug led us to consider pyrazinamide the cause of the erythema multiforme, but allergologic studies remained negative, except for the presence of circulating immune complexes. The mechanism of this eruption remains obscure, and definite withdrawal of pyrazinamide seems to be the best therapeutic choice.