Late lethal hepatitis B virus reactivation after rituximab treatment of low-grade cutaneous B-cell lymphoma.

The chimeric anti-CD20 monoclonal antibody, rituximab, is a promising treatment for cutaneous B-cell lymphomas. Classically used in combination with a multiagent-chemotherapy regimen, it can sometimes give excellent results alone. Because of its selective action on B lymphocytes, it is considered a moderate immunosuppressant in terms of infection. We describe a woman with relapsed cutaneous follicular centre B-cell lymphoma and secondary lymph-node involvement treated with rituximab alone, which induced a complete remission. One year later, she experienced a fatal hepatitis B virus (HBV) reactivation. Several such HBV reactivations were reported after combined rituximab and multiagent chemotherapy for B-cell lymphomas. This is the first case of HBV reactivation occurring during the year following rituximab monotherapy in the absence of any other immunosuppressive factor.

[Haemorrhagic cellulitis: three cases]. / Erysipèle hémorragique: intérêt d'une courte corticothérapie adjuvante (3 cas).

BACKGROUND: Haemorrhagic erysipelas (cellulitis) is a recently described clinical condition. We report 3 new cases of this rare bacterial dermatosis requiring both antibiotics and systemic corticosteroids for complete resolution. CASE REPORTS: Case 1 was a 75 year-old male patient, with a past history of hypertension and diabetes mellitus. Case 2 was a 69 year-old female patient with a past history of hepatic cirrhosis. Case 3 was a 56 year-old female patient without medical past history, except for obesity. All patients presented with a haemorrhagic and bullous erysipelas of the leg without clinical improvement under parenteral antibiotics. In all cases, adjuvant systemic corticosteroids (prednisone: 0.5 mg/kg/d) for 5-8 days in addition to antibiotics provided dramatic and complete resolution of skin lesions and disappearance of pain and fever. DISCUSSION: Haemorrhagic cellulitis may be misdiagnosed as necrotizing fasciitis because of ecchymotic areas with frequent bullae resulting in haemorrhagic crusts and partial inefficacy of antibiotics given alone. Adjuvant anticoagulant therapy or coagulation abnormalities may have facilitated the clinical condition in 2 of our 3 cases. The efficacy of adjuvant systemic corticosteroids during 5-8 days, in addition to antibiotics is the hallmark of this syndrome.

[Sarcoidosis: thalidomide treatment in ten patients]. / Sarcoïdose: traitement par thalidomide chez 10 malades.

BACKGROUND: Acute cutaneous sarcoidosis is generally spontaneously regressive but persistent chronic cutaneous lesions are esthetically prejudicial. There have been several case reports on thalidomide efficacy but long-term outcome is unknown. We report results in 10 cases of cutaneous sarcoidosis treated with thalidomide. PATIENTS AND METHODS: Data from ten patients with sarcoidosis treated with thalidomide between January 1998 and March 1999 were collected from delivery authorizations and analyzed. All ten patients had chronic cutaneous sarcoidosis resistant to conventional therapy. Six patients had an associated visceral localization and disease duration of 2 to 18 years (median 6 years). We considered that regression was complete when erythema and infiltration had totally disappeared, that regression was incomplete when cutaneous signs remained, and that treatment had failed when no effect was observed or when the disease worsened. RESULTS: Disease regression was noted in 7 patients for a daily dose of 1.84 mg/kg for 2.8 months. Skin lesions totally regressed in 3 patients, an incompletely in 4. Treatment failed in 3 patients. Patients were treated for 10 months (2 to 21 months). The daily dose of thalidomide was gradually reduced in 5 of 7 patients for whom treatment was effective. Three of these 5 patients relapsed and thalidomide was again given and was effective again at the same dose and after the same delay. We observed improved kidney function in one patient, improvement in nasal infiltration in one other and complete regression in 3 patients who achieved long lasting reduction in angiotensin convertase level. When treatment failed, the daily dose was 1.15 mg/kg and the treatment had to be stopped for 2 patients. Side effects were minor, excepting 2 cases of neuropathy. DISCUSSION: This open study of 10 patients treated with thalidomide showed the efficacy of a 1.84 mg/kg daily dose in 7 out of 10, but complete regression of the lesions was obtained in only 3 patients. Thalidomiide appears to suspend the disease, with relapse when the drug is discontinued and efficacy at re-introduction. This would argue against a placebo effect. The mode of action could involve immunomodulating and antiinflammatory mechanisms.

[Paraneoplastic acquired ichthyosis revealing non-Hodgkin's lymphoma]. / Ichtyose acquise paranéoplasique révélatrice d'un lymphome non Hodgkinien.

BACKGROUND: Paraneoplastic ichthyosis is a rare affection generally associated with malignant hemopathy. CASE REPORT: A 61 year-old man was seen with a generalized ichthyosis associated with a palmoplantar hyperkeratosis developed over the last 2 years, and an axillary lymph node. Histology of the lymph node revealed a large cell anaplastic lymphoma. Both ichthyosis and palmoplantar keratosis totally disappeared three weeks after adenectomy, without any other treatment. DISCUSSION: This rapid and complete regression of ichthyosis, after the sole ablation of the involved lymph node confirmed the paraneoplastic nature of the disorders of the keratinization (ichtyosis, palmoplantar keratodermia). The review of the literature showed only one case characterized by a rapid disappearance of ichthyosis after surgical treatment of the malignant lymphoma.