[Paraneoplastic multicentric reticulohistiocytosis]. / Histiocytose multicentrique paranéoplasique.

BACKGROUND: Multicentric histiocytosis (MH) is a rare form of histiocytosis of unknown aetiology and is associated with a malignant neoplasm in 25% of cases. Herein, we report the case of a female patient in whom HM enabled us to diagnose gastric carcinoma. OBSERVATION: A 74-year-old woman consulted for papules and nodules on the hands associated with destructive polyarthralgia of the interphalangeal joints and asthenia. Biopsy of a nodule revealed infiltration of the superficial dermis by numerous multinucleated giant cells containing eosinophilic cytoplasm; immunohistochemical analysis showed positive staining for CD68, confirming the diagnosis of MH. Additional screening tests for malignancy enabled us to diagnose gastric carcinoma. The cutaneous lesions disappeared several weeks after gastrectomy and no recurrence of HM or malignancy was seen in the ensuing 7 years. DISCUSSION: Fewer than 200 cases of HM have been reported. This non-Langerhans proliferative histiocytosis is a rare systemic disorder of unknown aetiology characterized clinically by papules and nodules associated with destructive polyarthralgia, and histologically by dermal proliferation of histiocytic multinucleated giant cells of skin, mucous membrane and synovial membrane. Routine screening for neoplasia should be performed following the discovery of HM as an association is seen in 25% of cases. However, the two diseases do not generally progress in parallel. In our case, the rapid disappearance of lesions within a few weeks of surgery suggests that HM was a true paraneoplastic syndrome.

Two giant orf lesions in a heart/lung transplant patient.

Orf is an infectious ulcerative stomatitis of sheep and goats. The responsible pathogen, parapoxvirus, may be transmitted to humans. Orf lesions are often atypical in immunocompromised individuals. The present report describes two very large exophytic lesions in a 31-year-old transplant patient receiving oral tacrolimus, mycophenolate mofetil and prednisone. Early surgical excision was successful, with no relapse after 14 months.

[Change in the plasma and urine levels of ionized fluorine under the influence of low doses of niflumic acid. Possible application to the treatment of osteoporosis]. / Variations des taux de fluor ionisé plasmatique et urinaire sous l'influence de faibles doses d'acide niflumique. Application éventuelle au traitement de l'ostéoporose.

Following several series of tests, it was shown that the administration of 500 mg/day of niflumic acid, at a dose of 250 mg morning and evening, causes in subjects with a weight between 65 and 75 kilos a moderate but permanent and relatively stable rise in the levels of plasma ionised fluorine. This constant concentration of ionised fluorine in the plasma contrasted with the marked and rapid variations which follow the ingestion of sodium fluoride, which is usually prescribed in the treatment of osteoporosis. This may explain why the fluoride ion is more active on osteogenesis when it is liberated in the organism from niflumic acid by way of metabolic processes. The dosage of 500 mg daily is much less than that which produces fluorosis after prolonged treatment; it suggests a trial of niflumic acid in the treatment of osteoporosis, respecting naturally the contra-indications, and supervising the digestive tract as always with anti-inflammatory drugs.

[Ionized fluorine in the plasma and urine of subjects treated with organofluorine drugs prescribed in rheumatology]. / Fluor ionisé dans le plasma et dans les urines de sujets traités par des médicaments organofluorés prescrits en rhumatologie.

The elimination of ionized urinary fluorine was studied in groups of eight subjects treated during several days with niflumic acid, flufenamic acid, sulindac, antrafenine and floctafenine. Sulindac and floctafenine do not changes this elimination. After administration of niflumic acid, flufenamic and antrafenine, the urinary elimination of ionized fluorine increase in all the subjects. This increase is manifested from the start of treatment and persists for several days after it has been stopped. The administration of three drugs also results in an elevated level of ionized plasmic fluorine the duration of treatment. The results prove the existence in the human organism of a metabolic process capable of effecting the ionization of the organic fluor contained in the drugs studied. This biotransformation causes a fluorine impregnation of endogenous origin that is permanent and relatively stable, and whose consequences are examined (risk of fluorine osteosis and possibility of therapeutic application).

[Fluorine osteosis caused by a very long-term niflumic acid treatment in 2 cases of rheumatoid arthritis]. / Ostéose fluorée secondaire à un traitement très prolongé par l'acide niflumique dans deux cas de polyarthrite rhumatoïde.

An osteosclerosis opacifying the axial skeleton and affecting in particular all of the spine, was observed in two women aged 75 and 42 years who had been suffering from a rheumatoid arthritis developing between 15 and 26 years. It was traced to a chronic fluorine intoxication, stemming from the regular taking, for 10 years and 8 1/2 years, of a non cortisone, anti-inflammatory niflumic acid. This fluorine product has 3 atoms of fluor in its molecule (50.0 mg for a tablet of 250 mg). Its administration to control subjects proved the production of ionized fluor by way of the metabolism, and the accumulation of fluor in the organism. Rheumatoid polyarthritis and the prolonged corticotherapy (10 mg of prednisone per day for 21 years) cannot be dismissed as the origin of the severe demineralization of the limbs observed in the second patient, but the role of fluorine seems marked in the occurrence of this peripheral involvement with problems of mineralization and secondary hyperparathyroidisms. On the other hand, the absence of an intervertebral narrowing in the 2 patients, despite the very prolonged taking of cortisone (5 mg of prednisone per day for 15 years, for the 75-year-old patient) is perhaps a result of the fluorine.