[Recurrence of cutaneous sarcoidosis during immune reconstitution syndrome in an HIV-infected patient]. / Récidive de sarcoïdose cutanée lors du syndrome de restauration immunitaire chez une patiente infectée par le VIH.

BACKGROUND: Association of sarcoidosis and HIV can occur in the context of immune reconstitution syndrome (IRS) after initiation of antiretroviral therapy (ART). Herein we report a case of cutaneous sarcoidosis in remission in an HIV-infected patient but relapsing during IRS associated with initiation of ART. PATIENTS AND METHODS: A 33-year-old female HIV-infected patient from Cameroon was treated with triple therapy with good efficacy. The patient previously had a small nodular lesion on her left cheek which disappeared spontaneously 2 months before the diagnosis of HIV infection. Three months after initiation of triple ART, the patient consulted again for recurrence of the lesion, which had gradually increased in size. Clinical examination revealed a purplish-red nodular plaque of lupoid appearance under vitropression, located between the inner corner of the eye, the nasal wing and the left cheek. A skin biopsy revealed giant-cell epithelioid dermal granulomas without caseous necrosis. Blood angiotensin-converting enzyme levels were elevated and intradermal reaction to tuberculin was negative. A diagnosis was made of cutaneous sarcoidosis. The patient was treated with chloroquine 200mg/day for 3 months, resulting in total subsidence of the lesions. No recurrence was observed at 1 year. DISCUSSION: Introduction of ART has changed the dermatological aspect of HIV infection. In addition to specific dermatological signs specific to HIV and to immunosuppression, there are the cutaneous adverse effects of antiretroviral drugs and skin disorders indicating reconstituted immunity during IRS. Schematically, three forms of IRS may be distinguished: the paradoxical form, the infectious form, and the inflammatory form. The latter corresponds to the onset or exacerbation of inflammatory conditions or autoimmune diseases after the start of ART. Thirty cases of association between sarcoidosis and HIV have been described, of which two-thirds occurred during IRS. The central role of CD4 in sarcoidosis explains its occurrence in HIV patients during reconstitution of the CD4 count. CONCLUSION: In HIV-infected patients treated with anti-retroviral treatment, certain skin diseases such as sarcoidosis may be related to IRS.

[Giant seborrhoeic keratosis in an unusual site]. / Kératoses séborrhéiques géantes de siège inhabituel.

BACKGROUND: Seborrhoeic keratoses (SK) are benign tumours preferentially located on the head and trunk. We report a case of giant SK at an unusual site. PATIENTS AND METHODS: An 85-year-old man consulted for pigmented genital lesions present for 10 years. Clinical examination revealed small pigmented formations evoking SK and other pigmented, confluent and hyperkeratotic bordering plaques with a circinate contour. The latter lesions were biopsied, and histological findings were characteristic of SK and showed epidermal acanthosis associated with orthokeratotic invagination of the mucosa, resulting in the formation of characteristic wells. Treatment by electrocoagulation curettage was undertaken. DISCUSSION: SK are benign tumours that occur primarily in patients aged over 50 years. They are preferentially located in the trunk, head and neck. A genital site of SK is very unusual, with no more than 10 published cases. The cause of genital SK is as yet unknown, but data in the literature point to a possible role of chronic friction and HPV.

[Maffucci syndrome and extensive verrucous epidermal nevi in the same leg]. / Syndrome de Maffucci et hamartome épidermique étendu sur le même membre.

BACKGROUND: Maffucci syndrome is a rare disorder characterized by multiple enchondromas associated with soft tissue haemangioma. We report a case of Maffucci syndrome associated with epidermal verrucous nevus. CASE REPORT: A 33-year-old woman, with no previous history of note, had presented multiple episodes of vascular tumefaction of the toes and verrucous lesions of the right lower limb since childhood. Clinical examination revealed multiple pain-free and round haemangiomas on the toes; some were hard and evocative of chondromas while others were soft and suggested angiomas. In addition, there was an epidermal verrucous nevus of the right lower limb. Skeletal examination revealed multiple phalangeal enchondromas. A diagnosis of Maffucci syndrome associated with epidermal verrucous nevus was made. DISCUSSION: Maffucci syndrome is a rare form of sporadic dysplasia characterized by superficial haemangiomas and cartilaginous tumours (enchondromas), with just over one hundred published cases to date. Localization in the bones of the hands is seen in 89% of cases, in contrast with our observation. While epidermal verrucous nevus may be associated with neurological or osseous anomalies, to our knowledge, association of epidermal verrucous nevus with Maffucci syndrome has not previously been described; the present association could of course be fortuitous.