[Cheyletiella dermatitis: an uncommon cause of vesiculobullous eruption]. / La cheyletellose: une etiologie inhabituelle d'eruption vésiculo- bulleuse.

BACKGROUND: Species of Cheyletiella mites are parasites hosted by dogs, cats and rabbits. In humans, they cause a dermatosis not well known by dermatologists. We report a case of an unusual, purely vesiculobullous eruption due to Cheyletiella blakei acquired from an infected cat. CASE REPORT: A 76-year-old woman presented a very pruritic eruption of vesicles and bullous lesions located on the trunk and external areas of the arms. Biopsy showed dermoepidermal cleavage and polynuclear infiltrate with prominent eosinophils, consistent with the diagnosis of bullous pemphigoid. We suspected a Cheyletiella dermatitis due to the aspect and distribution of the elementary lesions and the fact that prior to the eruption the patient had acquired a cat that sometimes slept in her bed. The diagnosis was confirmed by a veterinary examination and isolation of Cheyletiella blakei from the cat's skin. The cat was treated successfully with ivermectin, while the household was disinfected with permethrin. A treatment with benzyl benzoate (Ascabiol) resolved all the patient's symptoms. DISCUSSION: This case is particularly interesting due to the purely vesiculobullous pattern of the rash and by the difficulty and considerable delay of diagnosis. Patients who have recently acquired a cat or dog before developing a pruritic dermatosis may indeed have cheyletiellosis.

[Pretibial epidermolysis bullosa. A rare form of epidermolysis bullosa simplex]. / Epidermolyse bulleuse prétibiale. Une forme inhabituelle d'épidermolyse bulleuse simple.

INTRODUCTION: Pretibial epidermolysis bullosa had been classified as a rare localized form of autosomal dominant dystrophic epidermolysis bullosa. OBSERVATION: We report a sporadic case of a patient suffering from bullous lesions induced by minor trauma on pretibial skin. The lesions healed with atrophic scars. No milia formation was observed. The mapping of dermoepidermal junction by LH 7:2 and GB3 monoclonal antibodies was normal. By electron microscopy, numerous perinuclear vacuoles were observed and the cleavage occurred within the basal keratinocytes. DISCUSSION: This patient had clinical features in accordance with a diagnosis of pretibial epidermolysis bullosa. However, in contrast to previous case reports, the ultrastructural pattern was this of an epidermolysis bullosa of simplex type.

[Ultrastructural study of hereditary benign telangiectasia. Differential diagnosis from Osler Rendu disease]. / Etude ultrastructurale des télangiectasies héréditaires bénignes. Un diagnostic différentiel de la maladie de Rendu-Osler.

INTRODUCTION: There are two hereditary forms of primary telangiectasia with a totally opposite prognosis. In Rendu-Osler disease, also called hereditary haemorrhagic telangiectasia, there is a major risk of severe haemorrhage in adults. In benign hereditary telangiectasia there is no such risk. CASE REPORT: We report two brothers who were diagnosed as having Rendu-Osler disease. Under standard electron microscopy, a biopsy of a telangiectasia taken from the right arm pit showed that the vessels of the superficial reticular derma were dilated with thick walls but no dehiscences as in Rendu-Osler disease. DISCUSSION: This ultrastructure explains why there had been no haemorrhages in our two cases and favoured a diagnosis of hereditary benign telangiectasia.

Clinical manifestations of allergy and their relation to HIV infection.

In this retrospective study 141 HIV positive subjects were included. Allergy was studied by a specific questionnaire and the Phadia Top Test, an in vitro screening test for specific IgE. Both were related to the patients' history, clinical symptoms and the treatment used. Allergy was studied in reference to HIV negative controls and in relation to the clinical and biological subgroups of HIV patients. The statistical analysis (x 2 test) demonstrated a relationship between allergy and HIV infection and the clinical stage of AIDS-IKEL among patients with CD4 > 300 microliters, which may suggest that allergy contributes to the functional deficiency of these cells. We also demonstrated a high frequency of hypersensitivity reactions (75%) in HIV asymptomatic patients with CD4 < 300 microliters, which indicates that allergy could contribute to the early destruction of these cells. The allergic patients declared to be hypersensitive before contamination. Both mechanisms, functional deficiency and destruction of CD4 T-lymphocytes could be the result of the mediators, cytokines and enzymes released from the mast cells during IgE allergic reaction. Thus this study demonstrated that allergy could be a predisposing factor for the contamination and a polyvalent co-factor for the clinical and biologic evolution of HIV infection.