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.

[Therapeutic intensification and autologous stem cell transplantation in autoimmune diseases]. / Intensification thérapeutique et autogreffe de cellules souches hématopoïétiques pour le traitement des maladies auto-immunes.

THE PATHOPHYSIOLOGY of most autoimmune diseases is often poorly understood. EXPERIMENTAL CONSIDERATIONS and clinical experience suggest that high doses immunoablation followed by stem cell transplantation is a therapeutic option to consider for certain severe autoimmune disorders. THE CONCEPT OF RESTORING NORMAL IMMUNE REACTIVITY must in part br true since current results of 466 transplants (445 autologous, 21 allogeneic) patients suffering from various autoimmune diseases show a beneficial outcome in approximately 2/3 of the patients. TO IMPROVE THE EFFICACY AND SAFETY OF SUCH AN AGGRESSIVE PROCEDURE in patients with potentially affected vital organs by the underlying autoimmune disease, it is especially important to follow international consensus guidelines and to centrally collect clinical data for in depth analysis in the EBMT International Stem Cell Project for Autoimmune Disease in Basel, Switzerland. PHASE III STUDIES ARE RUNNING FOR SYSTEMIC SCLEROSIS (Astis, Autologous Stem cell Transplantation International Rheumatoid Arthritis Trial) started in 2003. A STUDY PROJECT IS PLANNED FOR MULTIPLE SCLEROSIS (Astims, Autologous Stem cell Transplantation International Multiple Sclerosis).

[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.

Familial aggregation of vitiligo in the French West Indies (Isle of Martinique).

Environmental factors are thought to influence the genetic transmission of vitiligo, and may change in families of different extraction. Most studies on vitiligo have been performed in occidental countries or in India, therefore, our purpose was to study the familial vitiligo aggregation in Martinique (French West Indies). Data on 16 families were collected from 1995 to 1999. Information was compared to 36 controls affected with sporadic vitiligo, using the chi(2) test. The prevalence among relatives of patients was 7%, as compared to 0.34% in the general population (p < 0.001). The age of onset of vitiligo was 31 in family cases and 33 in controls. Vitiligo occurred before the age of 20 in 19% of family cases and in 36% of controls. Most families (75%) have no more than 2 affected members. No difference was observed in triggering and environmental factors in family cases and controls. Our observations are in agreement with the literature data, leading to the assumption that the environmental factors involved in the expression of vitiligo in our island do not differ from other areas.

[Panniculitis induced by MINE chemotherapy]. / Hypodermite secondaire à une chimiothérapie de type MINE.

BACKGROUND: Drug-induced panniculitis are uncommon. We report the second case of panniculitis induced by MINE chemotherapy. CASE REPORT: A 31-year-old woman with relapsed Hodgkin disease was treated with MINE cytostatic regimen. Multiple erythematous and painful nodules of panniculitis developed on her chest, abdomen and thighs fifteen days after the beginning of drug administration with a second flare up after second administration of the same drugs. The eruption cleared slowly after treatment withdrawal. DISCUSSION: To our knowledge, our case is the second reported case of panniculitis induced by MINE chemotherapy. Drug-induced panniculitis is uncommon and usually induced by steroid treatment. Some cases of panniculitis induced by atenolol, potassium bromide, apomorphine, interferon alpha and interleukin 2 have been described. Few cutaneous adverse effects are reported with MINE chemotherapy: rash, erythema and swelling of extremities. A case of inflammatory swelling of thighs with hemorrhagic panniculitis due to this treatment has been described recently.

High prevalence of vitiligo in lepromatous leprosy.

BACKGROUND: Leprosy and vitiligo are common affections in the West Indies. Vitiligo frequently occurs in lepromatous patients, an observation rarely reported in the literature. METHODS: We studied the prevalence of vitiligo in patients affected by leprosy by performing a retrospective study between 1978 and 1999 in the French West Indies (Martinique). RESULTS: Eleven patients presented with vitiligo among 101 with lepromatous (multibacillary) leprosy. None presented with vitiligo among the 364 with the tuberculoid (paucibacillary) form. The mean age of the vitiligo patients was 55. 4 years at vitiligo onset. The sex ratio was 0.8. Vitiligo occurred 19 years after the diagnosis of leprosy, with a range from 3 to 42 years. The prevalence of vitiligo in lepromatous patients was 10.9%, compared to 0% in tuberculoid patients. Such an increase in prevalence compared with that in the general population (0.34%) was shown to be highly significant (P< 0.0001). CONCLUSIONS: Our data confirmed that the association of vitiligo and leprosy was not fortuitous. The physiopathology leading to this high rate of vitiligo in lepromatous leprosy is unclear, despite the fact that autoimmunity plays a major role in both diseases.

[Microsporum canis mycetoma of the scalp]. / Mycétome à Microsporum canis du cuir chevelu.

BACKGROUND: Mycetoma is a chronic subcutaneous tumefaction with presence of grains or granules. Etiological agents include bacteria or filamentous fungi. Mycetoma due to dermatophytes is uncommon, mainly occurring in Africa. To our knowledge, no case has been reported in the West Indies. Only two observations of Micosporum canis mycetoma in humans have been reported in the literature. We report a third case of mycetoma of the scalp caused by this fungus. CASE REPORT: A 22-year-old woman from Martinique, French West Indies, presented with an indolent tumefaction of the scalp evolving over five years. She had mental retardation due to congenital adrenal hyperplasia with 21-hydroxylase deficiency. The lesion was extracted surgically. Pathology and mycology examinations showed features of Microsporum canis mycetoma. Two months later, the scalp lesion recurred and the patient was treated with griseofulvin after surgical extraction. DISCUSSION: Mycetoma due to dermatophytes is very uncommon, mainly observed on the scalp and nape of the neck. A history of a skin lesion is frequent, leading to transcutaneous penetration of the fungus and mycetoma formation. Several dermatophyte species have been identified as causal agents (Microsporum ferrugineum, Trichophyton rubrum, Trichophyton verrucosum, Trichophyton mentagrophytes, Microsporum audouinii, Microsporum langeronii). Microsporum canis is rarely demonstrated in humans: two cases in children in Africa and Australia. Our observation was similar to the two cases in the literature: indolent and mobile tumefaction of the scalp, in a child or young adult, suggestive of lipoma or epidermal cyst, with excision leading to diagnosis. Association with tinea capitis and skin or nail involvement can also be observed.