[Clustered cases of histoplasmosis due to Histoplasma capsulatum var. capsulatum in Martinique: Case reports and environmental investigation]. / Cas groupés d'histoplasmoses à Histoplasma capsulatum var. capsulatum à la Martinique : description des cas et enquête environnementale.

Between the 24th of June and the 6th of July 2005, nine men came to Fort-de-France emergency department (Martinique, French West Indies) with more or less pronounced pulmonary symptoms associated in two cases with skin lesions. Three weeks before these nine men performed work in a deserted house. The diagnosis of histoplasmosis was based on pulmonary sample mycological analysis (direct examination and culture), molecular biology and serological tests. Interrogatory and environmental investigations on the presumed place of exposition to H. capsulatum var. capsulatum spores allowed confirming how and where contamination took place.

Phaeohyphomycosis Caused by a Novel Species, Pseudochaetosphaeronema martinelli.

Among the opportunistic mycoses that are emerging in patients with immunosuppression or severe underlying illness, many isolates lack of characteristic sporulation and until recently could not be identified. Clinical signs are mostly nonspecific and therefore such infections have often been disregarded. In the present paper we describe a novel, nonsporulating fungal species causing subcutaneous phaeohyphomycosis in two patients of different origin. One is a 73-year-old female from Martinique who suffered from rheumatoid arthritis, while the other case concerns a 72-year-old male from Mexico who had a history of type 2 diabetes mellitus. Sequencing of the partial ribosomal operon revealed that in both cases a member of the order Pleosporales was concerned which could not be affiliated to any family within this order. Multilocus analysis revealed that the fungus was related to another, unaffiliated agent of human mycetoma, Pseudochaetosphaeronema larense, and therefore the name Pseudochaetosphaeronema martinelli was introduced.

[Pyoderma gangrenosum and neutrophilic aortitis preceding the development of rheumatoid arthritis]. / Pyoderma gangrenosum et aortite neutrophilique précédant l'apparition d'une polyarthrite rhumatoïde.

BACKGROUND: We report a case of pyoderma gangrenosum (PG) associated with a complication comprising ascending aortic dissection (neutrophilic aortitis) in a setting of rheumatoid arthritis (RA). PATIENTS AND METHODS: A 79-year-old female patient was hospitalized in late 2009 for vegetating PG. Treatment with general steroids followed by colchicine and topical steroids resulted in complete healing of skin lesions. During hospitalization, the patient presented dissection of the ascending part of the aorta, for which emergency surgery proved effective. Histological examination of the excised tissue revealed diffuse neutrophilic aortitis. Diagnoses of Takayashu's disease and of lupus were ruled out. A chest CT scan showed interstitial lung disease with mild lymphocytosis in the bronchoalveolar fluid, but with no isolated pathogenic organisms. Relapse of skin lesions occurred 3 and 4 years later, associated with the development of RA, and worsening of the interstitial lung disease was noted in a scan carried out it in 2013, following which stabilization was observed in April 2014. There was no recurrence of the PG lesions. CONCLUSION: To our knowledge, no other cases involving association of neutrophilic aortitis with PG and RA has been published to date. The literature describes the emergence of the concept of systemic neutrophilic dermatoses, and this notion is reinforced by the presence of a cutaneous and aortic site of the neutrophilic disease in a single patient.

[Incidence and characteristics of calciphylaxis in Martinique (2006-2012)]. / Incidence et caractéristiques de la calciphylaxie en Martinique (2006-2012).

BACKGROUND: Calciphylaxis is a rare and severe disease with an annual incidence of around 1 % in dialysis patients. The main study aim was to determine its incidence in Martinique, where there is a significant population of patients on dialysis. PATIENTS AND METHODS: All patients diagnosed with calciphylaxis between 2006 and 2012 and living in Martinique were included, retrospectively. Social, demographic, biological, anatomic, pathological, histological and outcome data were analysed. RESULTS: Fifteen patients were included (8 women, 7 men). The incidence of calciphylaxis in this population was about 4.62/1,000,000 inhabitants per year. All patients presented very painful skin ulcerations and necrosis, chiefly on the lower extremities in 53.3 % of cases. All patients were on haemodialysis and two had undergone renal transplantation. Fourteen of the 15 patients were presenting secondary hyperparathyroidism, 12 had hypertension, 9 peripheral arterial disease, 8 obesity and 8 diabetes mellitus. Raised calcium and phosphorus were noted in 8 patients, with hypoalbuminaemia in 9 patients. Treatment with sodium thiosulfate was given for 8 patients, and was beneficial for all after a mean duration of 3.4 months. After 6 months of follow-up, 8 of the 15 patients were cured, 1 showed improvement and 6 had died. CONCLUSION: To our knowledge, this is the first study to examine the incidence of calciphylaxis in the general population. The relatively large number of patients could be accounted for by the high number of comorbidities in end-stage renal disease patients in Martinique, including obesity, diabetes, hypertension and arteritis. Treatment with sodium thiosulfate was beneficial for 8 patients.

[First case of phaeohyphomycosis due to Pleurostoma ootheca in a kidney transplant recipient in Martinique (French West Indies)]. / Premier cas de phaeohyphomycose à Pleurostoma ootheca chez un greffé rénal en Martinique.

Phaeohyphomycosis is a group of superficial and deep infections due to dematiaceous fungi. They are most common in tropical environments, especially in immunocompromised hosts. We describe the first case of phaeohyphomycosis due to Pleurostoma ootheca in a kidney transplant recipient in Martinique (French West Indies). A 59-year-old man with a kidney graft, treated with mycophenolate mofetil, tacrolimus, and prednisone, presented suppurative tumefaction of the left ankle. Cutaneous and osseous phaeohyphomycosis caused by P. ootheca was diagnosed, based on mycological, histological, and radiological testing. The patient's condition improved with posaconazole treatment. P. ootheca is a known environmental fungus. Immunocompromised hosts are more vulnerable to many infections, due to opportunistic pathogens. Bacteriological, histological, and mycological testing is required for accurate diagnosis and appropriate treatment. Treatment is not well defined and usually relies on antifungal agents or surgical resection or both. An important point to consider is that azole antifungal agents may cause major drug-drug interactions with immunosuppressive agents such as tracrolimus.

Scytalidium and scytalidiosis: what's new in 2012?

Fungi belonging to the genus Scytalidium are widespread around the world. Among them, two species are responsible for human superficial infections mimicking dermatophytosis: Neoscytalidium dimidiatum and Scytalidium hyalinum. Whereas these ascomycetous fungi are endemic in tropical or subtropical countries, both species have a different geographical distribution. Scytalidiosis represents approximately 40% of dermatomycoses in these areas. A few cases of invasive infections due to Scytalidium sp. have also been reported, assessing the ability of these fungi to behave as opportunists. Here we have reviewed the data on N. dimidiatum and S. hyalinum concerning their classification, clinical features, diagnosis and treatment. We also have presented the example of a specific consultation dedicated to nails in Martinique, in order to optimize the diagnosis and treatment of onychomycosis, many of which being due to Scytalidium sp. Even if Scytalidium cases are still rare in temperate countries, imported cases may increase in the future due to immigration and travel.

[Triple cutaneous mycosis (Cunninghamella bertholletiae, Phomopsis spp. and Paraconiothyrium spp.) in an immonucompromised patient: a Martinican case report]. / Mycoses cutanées àCunninghamella bertholletiae, Phomopsis sp. et Paraconiothyrium sp. chez un patient immunodéprimé : à propos d'un cas martiniquais.

INTRODUCTION: Patients from hematology department, with a weak immune system, can develop opportunist infections due to environment moulds that proliferate without notion of accidental inoculation or pre-existent lesion. CASE REPORT: We report a triple cutaneous infection case caused by Cunninghamella bertholletiae, Phomopsis spp. and Paraconiothyrium spp. on three different anatomic sites in a 68-years-old Martinican patient treated with high-dose chemotherapy and long-term corticotherapy for B-cell lymphoma and who also developed necrotic placards of legs. The patient's condition improved after stopping corticotherapy, treatment by voriconazole and medullary restoration. DISCUSSION: We will discuss about cases described in literature about those rare and different kinds of pathogenic agents while considering evolution, topography of lesions in our case, in order to focus on specificities. We shall emphasize the necessity to be careful about cutaneous hurt in immunocompromised patients.

[Occupational exposure to syphilis during venous ulcer curettage in Martinique]. / Accident professionnet d'exposition à a syphilis a près curetage d'ulcere veineux en Martinique.

The purpose of this report is to describe the first case of occupational exposure to syphilis. This accident occurred during curettage of a venous ulcer in a 68-year-old woman in Martinique Island. The patient presented primary syphilis without HIV. This case points out the need for enhanced syphilis screening in epidemic areas.

[Diagnosis of skin cancer by dermatologists in the French West Indies: a prospective study]. / Étude prospective de l'incidence des cancers cutanés dépistés en pratique dermatologique aux Antilles françaises.

BACKGROUND: The incidence of skin cancer is not well established in the French West Indies, aside from old data concerning cutaneous melanoma. METHOD: A prospective study was performed over a 3-month period in late 2007 in the French West Indies. The number of new cases of histologically confirmed skin cancer was determined using a questionnaire. RESULTS: The rate of participation of dermatologists was 82 %. During the study period, 166 skin cancers were diagnosed in 134 patients (66 women and 68 men: mean age=63.3 years, SD=2.5), including 137 basal cell carcinomas, 12 melanomas, seven squamous cell carcinomas, six Bowen's disease, one B lymphoma and one Paget's disease. The raw incidence of skin cancers detected by dermatologists was calculated as 64.6 cases/100 000 inhabitants/year for basal cell carcinoma, 5.7 cases/100 000 inhabitants/year for melanoma, 3.3 cases/100 000 inhabitants/year for squamous cell carcinoma, and 2.8 cases/100 000 inhabitants/year for Bowen's disease. Seven melanomas (almost exclusively of plantar topography) and seven basal cell carcinomas were diagnosed in patients of phototype V or VI. DISCUSSION: Although lower than in metropolitan France, the number of skin cancers diagnosed by dermatologists in the French West Indies is fairly high. In addition, this study indicates the significant incidence of basal cell carcinomas and melanomas in subjects with phototype V or VI, underreported in the literature. These findings highlight the need to begin longer-term studies and to include skin carcinomas in the cancer registry of the French West Indies in order to better identify their characteristics among the Caribbean population.

[Publication rate for oral presentations made at the Journées Dermatologiques de Paris meeting]. / Publication des communications orales présentées aux << Journées dermatologiques de Paris >>

BACKGROUND: The fate of oral presentations presented at a dermatological meeting has not been assessed to date. Our aim was to determine the publication rate for oral presentations presented at the "Journées dermatologiques de Paris" (JDP) meeting in peer-reviewed journals. Our secondary goals were to identify factors associated with publication and to examine the consistency of reporting of research findings presented in the conference abstract and subsequent full publication. METHODS: Abstracts presented orally at the JDP 1999-2004 were identified in the book of congress abstracts. Two independent operatives performed a Medline search cross-referencing lead and last authors and keywords. RESULTS: The publication rate was 57.6% with mean time to publication of 20.3months. The median impact factor was 2.8. Factors associated with subsequent publication were study topic (p=0.04 for oncology) and study type (p=0.03 for fundamental research and p=0.005 for randomized controlled trials). The congress abstracts and full-text publication differed primarily in terms of sample size and data given in the "Results" section. DISCUSSION: More than half of all abstracts presented orally at the JDP congress are subsequently published in journals with a median impact factor comparable to those seen for other scientific congresses for which similar analysis has been conducted. These results confirm the scientific quality of this particular congress, in addition to its vocation of continuous medical training.

[Ulcerated nodular lesions on extremities of patient undergoing treatment for glioblastoma on French Caribbean island of Martinique]. / Lésions nodulaires et ulcérées des membres chez un Martiniquais traité pour un glioblastome. Phaéohyphomycose à Exophiala spinifera.

Phaeohyphomycosis comprises a disparate group of cutaneous and systemic mycotic infections caused by dematiaceous fungi. The Exophiala genus includes more than 20 species. The purpose of this report is to describe a case of phaeohyphomycosis due to Exophiala spinifera in a patient under treatment for cerebral glioblastoma on the French Caribbean island of Martinique. A 73-year-old man who was undergoing treatment for a cerebral glioblastoma using radiotherapy, chemotherapy and systemic corticosteroids presented with ulcerated nodular lesions on all four extremities for several months. Histological and mycological examinations led to diagnosis of cutaneous phaeohyphomycoseis due to Exophiala spinifera. Treatment using itraconazole was initiated but the patient died from complications of glioblastoma. Phaeohyphomycosis is a rare and cosmopolitan mycosis. Infection due to Exophiala spinifera is uncommon in humans. It usually but not always occurs in immunocompromised hosts. Although cutaneous involvement is usually localized and has a favorable prognosis, disseminated forms may occur and can be life-threatening. Histological and mycological examinations are useful to confirm the diagnosis. Systematic antifungals with or without surgical resection are often effective. To our knowledge, only 15 reported cases of phaeohyphomycosis due to Exophiala spinifera have been reported up to now.

Cannabis arteritis: a new case report and a review of literature.

Cannabis arteritis manifests in cannabis users, independently of tobacco consumption. Around 50 cases were reported in the literature since the first description of this entity in 1960. We report the case of a 36-year-old man, cannabis user, without vascular risk factor who developed digital necrosis on the right foot. The pedal pulses were not palpable. He had no abnormal laboratory findings. Arteriography revealed distal segmental lesions and occlusion of popliteal artery. This arteritis was linked to cannabis use, but the patient did not stop cannabis consumption. His symptoms became even worse and he eventually developed sub-acute ischaemia in his left leg despite vascular treatments. Amputation of the right second toe and of the left leg finally became necessary. Cannabis arteritis is relatively similar to thromboangiitis obliterans in its clinical and arteriographical presentation. A parallelism can be made between the role of tobacco in thromboangiitis obliterans pathogenesis and the role of cannabis in cannabis arteritis. Cannabis use must be searched in young patients presenting with arteriopathy. Cannabis arteritis may indeed represent a frequent cause of juvenile peripheral obstructive arterial disease, but is probably under-diagnosed.

[Subcutaneous phaeohyphomycosis due to Exophiala spinifera in a renal transplant recipient]. / Phaéohyphomycose sous-cutanée à Exophiala spinifera chez une malade greffée rénale.

INTRODUCTION: Among the dematiaceous fungi responsible for human or animal phaeohyphomycosis, the Exophiala genus is a well-known etiologic agent and presently includes nine species considered as opportunist pathogens. To our knowledge, Exophiala spinifera has been reported as causative agent of only thirteen cases of cutaneous or systemic phaeohyphomycosis. We describe some typical phaeohyphomycotic cysts. CASE-REPORT: A 59 year-old female renal transplant recipient, treated with ciclosporine and prednisone, presented with two painless nodular and suppurative lesions of the leg, extending slowly. Histological and microbiological examinations identified Exophiala spinifera. The patient's condition improved with voriconazole treatment. DISCUSSION: Phaeohyphomycosis is a rare but cosmopolitan mycosis found throughout the world. Immunocompromised hosts are more vulnerable to these infections and more likely to develop severe and disseminated forms of uncertain outcome. Mycological and histological findings are important to confirm the diagnosis. The prognosis is benign and complete cure is common in cutaneous and superficial forms. Treatment is not well defined, often empirical and usually relies on antifungals and/or complete surgical resection.

[Lichenoid cutaneous reaction to imatinib]. / Toxidermie lichénoïde à l'imatinib (Glivec).

INTRODUCTION: Imatinib (Glivec) is a new therapeutic molecule used for the treatment of chronic myeloid leukemia. Cutaneous side effects with this treatment are common but lichenoid drug eruption is exceptional. We report the first case with profuse cutaneous lichen. CASE REPORT: A 52 year-old woman presented with a 5-year history of chronic myeloid leukemia. The different chemotherapies had failed (persisting polyadenopathies and splenomegalia). She was treated with imatinib (400 mg/day). Two months after the beginning of this treatment a disseminated cutaneous eruption appeared on the trunk, legs, arms and face without mucosal involvement and composed of dark purple, prurigenous, papules suggestive of lichen planus. The cutaneous biopsy confirmed the diagnosis of lichen planus. Suspension of the drug led to the complete regression of the eruption, without any other local treatment, within 2 months. Reintroduction of the drug led to the recurrence of the lesions. DISCUSSION: Cutaneous reactions to imatinib are common and occur in 11 to 67 p. 100 of patients depending on the series. More severe cutaneous reactions have been described: exfoliating dermatites, generalized pustulosis, epidermal necrolysis. The aspect of profuse lichenoid eruption of the skin and the correlation with cutaneous lesions clinically and histologically evocative of lichen planus has not been described other than an isolated buccal involvement in a 72 year-old woman. In our patient, study of the imputability criteria is in favor of imatinib's responsibility.

[Nail disease due to Scytalidium in Martinique (French West Indies)]. / Onychomycoses à Scytalidium en Martinique.

INTRODUCTION: Scytalidium is an endemic mold in tropical and subtropial areas. Our purpose was to study the prevalence and clinical and epidemiological features of onychomycoses due to Scytalidium in Martinique (French West Indies). PATIENTS AND METHODS: We performed a prospective study on 106 patients (46 men and 60 women) with clinical onychomycosis, in the dermatological department of the Centre Hospitalier Universitaire of Fort-de-France. All patients underwent mycological sampling and were divided into two groups depending on the presence or not of Scytalidium. Age, sex, localization, clinical aspects, time of duration and environmental factors (place of residence, garden, animals, bare foot walk, immunodepression) were compared between the two groups using chi2, Fisher and Student's t test. Ten control volonteers without clinical onycomycosis underwent mycological sampling. RESULTS: Onychomycosis due to scytalidium represented 42 p. 100 of patients (Scytalidium hyalinum in 91 p. 100 of cases) and 56 p. 100 after elimination of patients with negative results. Medium age was significantly higher in Scytalidium group (62 versus 54 years; p<0.02). Toe nail was involved in 95 p. 100 of patients (big toe nail in 77 p. 100). Sole involvement was more frequent in Scytalidium group (47 p. 100 versus 14 p. 100; p<0.001). Sampling of controls showed scytalidium in one case. DISCUSSION: Our study confirmed the endemicity of Scytalidium hyalinum in Martinique and the frequence of sole involvement. Presence of Scytalidium without clinical features in one control is of epidemiological interest, and may explain the frequence of the disease.

Grains, growth, and grooving.

We report the in situ investigation of grain growth and grain boundary migration, performed with a variable-temperature scanning tunneling microscope (STM) on a polycrystalline gold film. Atomic step resolution allowed us to identify the individual grains and, thus, also the grain boundaries. Our special, thermal-drift-compensated STM design made it possible to follow the same sample area over large temperature intervals. In this way, we have directly observed grain boundary migration and grain growth. In a first quantitative analysis we correlate the observed, unexpected changes in surface roughness with the evolution of the grain and grain boundary configuration.

Aumento de antioxidantes en sangre y de las concentraciones de selenio en pacientes negros con fase activa de vitíligo / Increased in total blood antioxidant status and selenium levels in black patients with active vitiligo

Antecedentes; El estrés oxidativo es un fenómeno importante en la muerte de los melanocitos en el vitiligo. Recientemente se ha encontrado una acumulación de peróxido de hidrógeno (H2O2) y niveles bajos de catalasa en la epidermis de pacientes con vitiligo. Se han visto pocas alteraciones de los antioxidantes en la sangre de pacientes con vitiligo, excepto una elevación del selenio. No se han realizado estudios sobre el estrés oxidativo hasta ahora, en pacientes con un fototipo VI de piel (clasificación de Fitzpatrick). Objetivo: Estudiar el estado antioxidante en la sangre de pacientes negros con vitíligo generalizado activo. Métodos: Se evaluaron el estado antioxidante total Randox, y las concentraciones de selenio, ferritina, transferrina, ceruloplasmina, tocoferol y retinal en muestras de sangre de los pacientes de piel negra de las indias Occidentales Francesas (de Martinica) con lesiones activas recientes de vitíligo y de 8 voluntarios sanos equiparados en edad y sexo. Resultados: El estado antioxidante total de la sangre y las concentraciones de selenio aumentaron significativamente en los pacientes con vitiligo, en comparación con los controles equiparados en sexo y edad (p<0,01 y p<0,02, respectivamente). No se modificaron significativamente las concentraciones en sangre de ferritina, transferrina, ceruloplasmina, retinol y tocoferol. Conclusiones: Este es el primer trabajo sobre el estado antioxidante global en sangre en el vitíligo. El aumento del estado antioxidante total en sangre observado en pacientes negros fue un resultado inesperado que necesita confirmarse y explicarse por otros estudios. El aumento espontáneo de las concentraciones de selenio podría ser interesante, puesto que este elemento ha sido recomendado en el tratamiento del vitíligo (AU)

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