[TIBOLA: an emerging clinically polymorphous rickettsiosis]. / TIBOLA : une rickettsiose en expansion, cliniquement polymorphe.

BACKGROUND: TIBOLA (tick-borne lymphadenopathy) is a rickettsiosis caused chiefly by R. slovaca, transmitted by a Dermacentor tick. We report five cases. PATIENTS AND METHODS: Three patients were diagnosed at the initial inflammatory stage (facial oedema, necrotic eschar, lymphadenopathy, fever) and two at the stage of sequelae (alopecia and fatigue). Microbiological evidence was present in only one case. DISCUSSION: TIBOLA is a form of rickettsiosis that is currently spreading in Europe. Clinical diagnosis is often made late because of the mild symptoms and the lack of knowledge among clinicians concerning the condition. Microbiological tests (serology, PCR, culture of eschar or serum samples) are negative in one third of cases. The reference treatment consists of antibiotics effective against intracellular bacteria, cyclines and macrolides.

[Acne and osteoarticular manifestations]. / Acné et manifestations ostéoarticulaires.

Certain severe forms of acne vulgaris may be accompanied by disorders of the locomotor system. Fulminant acne is manifest as an acute disorder with an alteration of general health and with fever, the onset of painful, necrotic skin lesions, myalgia and arthralgia with arthritis of one or more joints. Acne conglobata, a chronic disorder, is defined by the presence of comedones in sebaceous gland ducts and its progression to form nodules and pustules, leaving indelible scars. Osteoarticular involvement which occurs during the course of acne conglobata, and whose incidence is difficult to determine, is characterized by the frequent presence of sacroiliac inflammation. However, these two forms of acne are often confused and the authors outline differences between them. A more accurate identification of cutaneous manifestations would perhaps provide an eventual classification of "rheumatic disturbances of acne" whose nosological category has not yet been determined.

Collagen studies in congenital cutis laxa.

A case of congenital cutis laxa (CCL) of unclear mode of inheritance associated with multiple pulmonary artery branch stenosis was extensively investigated to assess possible correlations between clinical, ultrastructural, and biochemical features. Light microscopy revealed that elastic fibers were absent in the papillary dermis, while hypoplastic elsewhere. Transmission electron microscopy showed a poor elastin matrix content in some elastic fibers, variable diameters of collagen fibrils, and abundant glycogen granules in most dermal cells. Measurement of collagen fibril diameters, using an image analyzer, was carried out in the patient and two age- and site-matched controls. A bimodal distribution was found in the upper reticular dermis of the patient. In vitro analysis of collagen in skin fibroblast cultures of the patient showed increased collagen synthesis with a balanced production of type I and type III procollagens. Our study confirms that CCL represents a disorder both of collagen and elastic connective tissue.