ABSTRACT
Thermal burns can occur during seizure. This diagnosis can be difficult in case of atypical lesions, even more if the epilepsy is unknown and in case of seizures with loss of consciousness and/or an unwitnessed epileptic attack. We report two cases of cutaneous bullous lesions initially misdiagnosed as severe acute cutaneous adverse reactions (generalized bullous fixed drug eruption and Stevens-Johnson syndrome). In the two cases, the clinical aspect, necrotic evolution, and absence of obvious attributable medication allowed to revert to the diagnosis of burns due to boiling water revealing previously unknown epilepsy. For both, surgical management with skin graft was performed, and antiepileptic treatment was introduced. Facing unexplained burns, occult epilepsy should be investigated. Questioning of patient and relatives is crucial.
Subject(s)
Burns/etiology , Burns/therapy , Epilepsy/complications , Water , Adolescent , Aged, 80 and over , Anticonvulsants/therapeutic use , Epilepsy/drug therapy , Female , Humans , Male , Missed Diagnosis , Skin Transplantation , Stevens-Johnson Syndrome/diagnosisABSTRACT
BACKGROUND: Kaposi sarcoma is a vascular tumor related to herpesvirus-8 and is promoted by immunosuppression. For the last 15 years, human immunodeficiency virus (HIV) patients have had access to organ transplantation. The dual immunosuppression of HIV and immunosuppressive treatments might increase the risk and severity of Kaposi sarcoma. METHODS: We conducted a multicentric retrospective study by collecting cases from French databases and society members of transplanted patients, among which 7 HIV-infected patients who subsequently developed Kaposi sarcoma were included. RESULTS: In the CRISTAL database (114 511 patients) and the DIVAT (Données Informatisées et VAlidées en Transplantation) database (19 077 patients), the prevalence of Kaposi sarcoma was 0.18% and 0.46%, respectively, in transplanted patients; these values compare with 0.66% and 0.50%, respectively, in transplanted patients with HIV. The median time from HIV infection to Kaposi sarcoma was 20 years. Kaposi sarcoma occurred during the first year after transplantation in most cases, whereas HIV viral load was undetectable. Only 2 patients had visceral involvement. Five patients were treated with conversion of calcineurin inhibitor to mammalian target of rapamycin inhibitor, and 5 patients were managed by decreasing immunosuppressive therapies. At 1 year, 4 patients had a complete response, and 3 had a partial response. CONCLUSIONS: In our study, Kaposi sarcoma in transplanted patients with HIV did not show any aggressive features and was treated with the usual posttransplant Kaposi sarcoma management protocol.
Subject(s)
Anti-HIV Agents/adverse effects , HIV Infections/drug therapy , Herpesvirus 8, Human/immunology , Immunocompromised Host , Immunosuppressive Agents/adverse effects , Organ Transplantation/adverse effects , Sarcoma, Kaposi/immunology , Adult , Aged , Antiretroviral Therapy, Highly Active/adverse effects , Databases, Factual , Female , France/epidemiology , HIV Infections/epidemiology , HIV Infections/immunology , Herpesvirus 8, Human/pathogenicity , Humans , Male , Middle Aged , Prevalence , Retrospective Studies , Risk Factors , Sarcoma, Kaposi/epidemiology , Sarcoma, Kaposi/therapy , Sarcoma, Kaposi/virology , Time Factors , Treatment OutcomeSubject(s)
Biological Products/adverse effects , Crohn Disease/drug therapy , Infliximab/adverse effects , Melkersson-Rosenthal Syndrome/microbiology , Mycobacterium tuberculosis/isolation & purification , Tuberculosis, Cutaneous/microbiology , Tuberculosis, Pulmonary/microbiology , Adolescent , Antitubercular Agents/therapeutic use , Biopsy , Colonoscopy , Crohn Disease/diagnosis , Crohn Disease/immunology , Female , Humans , Immunocompromised Host , Melkersson-Rosenthal Syndrome/diagnosis , Melkersson-Rosenthal Syndrome/drug therapy , Melkersson-Rosenthal Syndrome/immunology , Mycobacterium tuberculosis/drug effects , Mycobacterium tuberculosis/immunology , Risk Factors , Severity of Illness Index , Treatment Outcome , Tuberculosis, Cutaneous/diagnosis , Tuberculosis, Cutaneous/drug therapy , Tuberculosis, Cutaneous/immunology , Tuberculosis, Pulmonary/diagnosis , Tuberculosis, Pulmonary/drug therapy , Tuberculosis, Pulmonary/immunology , Tumor Necrosis Factor-alpha/antagonists & inhibitors , Tumor Necrosis Factor-alpha/immunologyABSTRACT
OBJECTIVE: Ulcerative colitis (UC) is a chronic inflammatory condition. Previous reports suggested that UC may have a worse prognosis when associated with auto-immune diseases. We compared characteristics at diagnosis and natural history of the disease between classical ulcerative colitis (CUC) and UC associated with auto-immune diseases (CAI) in children. MATERIAL AND METHODS: In this study, 67 children followed for UC at Nancy University Hospital between 1993 and 2012 were included: 45 patients in the CUC group and 22 in the CAI group. RESULTS: Median follow-up was 4.8 years. Median age at diagnosis was 11.6 years in the CAI group and 9.8 years in the CUC group. Time between symptoms onset and diagnosis was broadly similar in the two groups (<3 months) and there were no significant differences regarding biological and histological findings. At 5 years, the need for corticosteroids and azathioprine did not differ between the CAI and the CUC groups. There was also no significant difference between the two groups regarding infliximab use at 1 and 5 years. CONCLUSIONS: In this pediatric study, CAI had similar characteristics at baseline as CUC. The course of CAI does not seem to be influenced by the presence of concomitant auto-immune diseases.
