[Generalized bullous pemphigoid induced by radiotherapy]. / Pemphigoïde bulleuse généralisée induite par une radiothérapie.

BACKGROUND: There have been a very small number of reported cases of radiotherapy-induced autoimmune bullous disease. We describe a case of generalised autoimmune sub-epidermal bullous pemphigoid (BP) induced by radiotherapy in a female patient presenting squamous cell carcinoma of the vulva. CASE REPORT: In June 2008, a 48-year-old woman underwent vulvectomy with lymph node curettage for squamous cell carcinoma of the vulva. Following surgery, adjuvant radiotherapy was indicated. At the 16th session (dose of 32 Gy), erythema occurred on the irradiation field. At the 23rd session (46 Gy), the patient presented bullous lesions that became generalised after four days with involvement of the oral mucosa. Skin biopsy revealed sub-epidermal bullae and direct immunofluorescence showed continuous linear deposits of IgG and of C3 along the dermal-epidermal junction. Indirect immunofluorescence revealed the presence of antibodies directed against the basement membrane. A favourable outcome was achieved under systemic corticosteroids. No immunotransfer analysis of serum or any other immunological investigations were performed. DISCUSSION: The clinical and histological features of this autoimmune bullous disease were evocative of BP, despite the absence of any formal proof. Radio-induced BP is extremely rare, with only 28 cases being described to date in the literature. The trigger mechanism is poorly understood; radiotherapy appears to cause changes in the antigenic properties of proteins in the dermal-epidermal junction resulting in production of autoantibodies. The radio-induced nature of BP does not affect therapeutic response. The case we report is novel in terms of both generalisation of the eruption and mucosal involvement.

[Metastatic pure testicular seminoma of the skin]. / Métastase cutanée d'un séminome testiculaire pur.

Seminomas are germinal tumors from testicular cells in men. Cutaneous metastasis are very rare. The authors report the case of a 56-year-old male patient admitted for treatment of an enlarged left testicular mass. Physical examination revealed a cutaneous nodule on the right side of the back. Histopathologic examination of both orchiectomy materiel and cutaneous lesion revealed pure seminoma. Chest and abdomen-pelvis CT revealed a pulmonary metastatic nodules, enlarged para-aortic lymph nodes and metastatic lesions in the adrenals glands. The patient died six months after diagnosis due to complications of metastatic disease despite adjuvant chemotherapy. To our knowledge, we report the first case demonstrating that seminoma may spread to skin.

[Melanoma in HIV patients: 14 cases]. / Mélanomes chez des patients séropositifs pour le VIH : 14 cas.

BACKGROUND: a clinical study of 14 patients presenting both malignant melanoma and HIV infection, and analysis of the literature to determine the frequency and specific features of this association. PATIENTS AND METHODS: ten men and four women of median age 43 years were included. In 50% of cases, the primary melanoma consisted of spreading superficial melanoma with a mean Breslow thickness of 2.83 mm. In two cases, regional lymph node metastasis was discovered but with no primary melanoma being identified. HIV infection was already documented on diagnosis of melanoma in 11 cases, and it was discovered in three cases at the time of surgery for melanoma (treatment of the primary melanoma in two cases, and in one case, regional lymph node dissection two years after the initial diagnosis). Eight patients died within a mean period of 39 months, with melanoma being the cause of death in six cases. Following relapse of melanoma, the course of the disease was severe, with mean stage IV survival of 3.6 months. No response to chemotherapy was observed where such treatment was feasible. DISCUSSION: the presence of HIV appears to be an aggravating factor for the outcome of metastatic melanoma. CONCLUSION: our study suggests the importance of clinical examination of pigmented lesions in HIV patients in order to ensure early identification of melanoma.

Childhood cutaneous leishmaniasis: Experience of a Moroccan unit of dermatology.

OBJECTIVE: We undertook a monocentric retrospective analysis of childhood leishmaniasis in order to describe the epidemio-clinical profile, therapeutic characteristics and clinical outcomes of affected patients. PATIENTS AND METHODS: The files of all children treated for cutaneous leishmaniasis (CL) in the Dermatology Department of Ibn Sina University Hospital over an 11-year period were reviewed. RESULTS: A total of thirteen children were included. The mean age was 10.2 years and the sex ratio (F/M) was 5.5. All patients lived or had stayed in an endemic area. The average delay of diagnosis was 11.8 months. The most frequent clinical finding consisted of ulcers (61.5%), usually located on the face (69.2%). The clinical diagnosis was confirmed by parasitologic smear in 76.9 percent of cases. The treatment used was intralesional meglumine antimoniate in twelve cases. The outcome was favorable in all cases. CONCLUSION: Our series is characterized by a female predominance and the patients presented with a single lesion. The lesions were frequently located on the face and a favorable outcome was obtained after treatment with intralesional meglumine antimoniate.

The immune function and measles virus infection in three different socioeconomic child populations in Karachi, Pakistan.

The immune function as well as anti-measles virus antibody level were investigated with 111 children in Karachi who were classified into high-, middle- and low-income groups. No difference in the blood cell counts or the biochemical data among three groups indicates no marked difference in the general health conditions among them. In the low-income group, levels of IgG, IgA and anti-measles virus antibody were significantly higher than those in the other two groups. Although 30% of children of the low-income group kept extremely high levels of immunoglobulin, no significant correlation was observed between IgG levels and anti-measles virus antibody levels. In the high-income group, the level of IgM was significantly lower and the incidence of anti-measles virus antibody-negative children was high (7/38; 18.4%). These antibody-negative children kept lower immunoglobulin levels although they were over four years old. These results suggest that the living environmental conditions of these different socioeconomic groups vary greatly and hygienic conditions must influence the chance of encountering infectious pathogens including measles virus. The relation between living environment and risk of subacute sclerosing panencephalitis (SSPE) in child population of Krachi is discussed.