[Graft-versus-host disease: Review of 22 cases]. / Maladie du greffon contre l'hôte: revue de 22 cas.

PURPOSE: Graft-versus-host disease (GVHD) is one of the major complications of allogeneic bone marrow transplantation. Twenty-two patients, who had an allogeneic bone marrow transplantion at the Institute J. Bordet, developed a GVHD proven by a biopsy. RESULTS: Twenty-two cases of GVHD were registered; 17 of these patients suffered from the acute form of the disease. All the patients presented the characteristic skin lesions, usually associated with other organ involvement. Most of the cases suffered from relapse after a time-limited response or from resistance to therapy, despite an effective treatment. Uncontrolled GVHD led to the death of two patients. CONCLUSION: GVHD is a frequent pathology that significantly contributes to the morbidity and mortality associated with bone marrow transplantation, despite appropriate management. Recognition of clinical and histopathological features of GVHD is important for dermatologists involved in the care of bone marrow transplant patients. Actually, bone marrow transplantation is now easily and more frequently performed than in the past.

[The dermatology department]. / Le Service de Dermatologie.

The department of dermatology has developed a broad clinical activity with a particular expertise in oncology, allergology, psoriasis and gynecological dermatology. Research has also been developed in these areas.

[Validity of the tympanic infrared thermometer in geriatric inpatients]. / De validiteit van de tympane infrarood thermometer bij gehospitaliseerde, geriatrische patiënten.

The purpose of this study was to assess the agreement between rectal temperature and infrared emission detection (IRED). The specificity and sensitivity, the positive predictive value and the negative predictive value were calculated. It was a prospective, observational and unblinded study. Thermoscan-pro-1 was used to collect pairs of data in 41 patients, all hospitalised on an acute geriatric ward during a 4-month period. 41% of the patients were febrile. The 'bias' between rectal and tympanic measurement (left ear) was -0.64 degree C (d) and the standard deviation 0.58 degree C (s). The '95% Confidence Interval' for the bias was -0.82 degree C and -0.46 degree C. The '95% limits of agreement' between the rectal measurement and the tympanic measurement (left ear) was -1.78 degrees C and 0.50 degree C. Regression analysis taught us that bias was increasing with increasing temperature. If we take into account one measurement with the IRED ear thermometry, the sensitivity was 41%, the specificity 83%. The positive predictive value was 64% en the negative predictive value 67%. We can conclude that the IRED ear thermometry is not a valuable alternative for the rectal, digital thermometry in the elderly, frail and febrile hospital inpatients.

Warty carcinoma of the anus: a variant of squamous cell carcinoma associated with anal intraepithelial neoplasia and human papillomavirus infection.

Warty carcinoma (WC) is a rare variant of squamous cell carcinoma primarily described in the vulva in younger women and classically associated with human papillomavirus (HPV) infection. The gross findings are similar to those of verrucous carcinoma with large, exophytic tumors with a papillomatous surface. Microscopically, the tumor is papillated and contains fibrovascular cores covered by hyperkeratotic epithelium showing presence of koilocytes. We report a case of anal squamous cell carcinoma showing similar features, occurring in a young immunosuppressed male patient with a history of multifocal anal intraepithelial neoplasia (AIN). HPV-16 has been demonstrated both in the WC and in adjacent AIN, but the HPV status appears different in the two lesions: integrated in WC and episomal in AIN lesions. We also have demonstrated by immunohistochemistry that both WC and AIN are highly proliferative entities sharing the same MIB-1 pattern, and that WAF1/CIP1 protein expression is common in the two lesions irrespective of p53 protein expression.

Value of standard laboratory tests for the early recognition of group A beta-hemolytic streptococcal necrotizing fasciitis.

The laboratory data for 17 patients with group A beta-hemolytic streptococcal necrotizing fasciitis (GAS NF) were compared with data for 145 patients hospitalized for cellulitis during the same period. Admission values of C-reactive protein and creatine kinase were higher for patients in the group with GAS NF than for patients in the group with cellulitis (P<.001), suggesting that standard laboratory tests may be useful for the early differential diagnosis of GAS NF and cellulitis.

[Stings, bites and other adventures...]. / Piqûres, morsures et autres aventures....

Most of us live in cities and nature seems beneficial. Unfortunately, invertebrates and vertebrates may be aggressive. We will try here a review of the diseases caused by arthropods and other noxious animals. Injuries caused by the following insects will be described: mosquitoes, flies, fleas, bees, wasps and ants, bugs, beetles, butterflies and caterpillars. In the class arachnida: spiders, scopions, ticks and mites. Among invertebrates: leeches, anemons, corals, sea urchins, sponges and mollusca. Noxious or venomous vertebrates will not be forgotten. Basic and practical attitudes are proposed.

[Primary and isolated cutaneous lymphomatoid granulomatosis following heart-lung transplantation]. / Granulomatose lymphomatoïde à localisation cutanée isolée après une transplantation cardio-pulmonaire.

BACKGROUND: Lymphomatoid granulomatosis is an Epstein-Barr virus-associated B-cell lymphoproliferative disease. It is angiocentric and angiodestructive and involves the lungs, central nervous system and skin. Exclusive cutaneous involvement is rare and may be associated with a better outcome. Contrarily to the extra-cutaneous forms of lymphomatoid granulomatosis, it is difficult or impossible to detect Epstein-Barr virus DNA sequences in primary and isolated cutaneous lymphomatoid granulomatosis. CASE REPORT: A 54-year-old woman developed erythemato-violaceous lesions on both legs 3 years after a heart-lung transplantation. The diagnosis of erythema multiforme and of drug-induced vasculitis were first made. Because of fever and of the rapid extension of the lesions, the patient was hospitalized. The histologic examination of the first lesions showed a perivascular infiltrate, without epidermotropism, composed of histiocytes, lymphocytes and plasma cells. Immunohistochemistry revealed the presence of a predominantly T-cell infiltrate with some large B cells. Subsequent biopsies were diagnosed as high grade B-cell lymphoma. Polymerase chain reaction analysis as well as in situ hybridation study showed the presence of Epstein-Barr virus load in the lesions. There was however no serologic evidence of viral reactivation. Extensive systemic evaluation revealed no visceral or bone marrow involvement. Despite antiviral treatment and CHOP polychemotherapy, the patient died 3 months after her admission. DISCUSSION: This observation of lymphomatoid granulomatosis is particular because of its exclusive cutaneous involvement associated with a fulminant evolution to high grade B lymphoma. The presence of a context of iatrogenic immunosuppression underlies the role of altered immune cellular functions in the initiation and/or progression of lymphomatoid granulomatosis and strengthens the role of a viral agent in its pathogenesis. We suggest that the presence of Epstein-Barr virus, which is generally not associated with the isolated cutaneous forms of lymphomatoid granulomatosis, may have played a role in this fulminant evolution to high grade B lymphoma.

Classic Kaposi's sarcoma after multiple-partner heterosexual behavior in Central Africa.

We present a case of a possible sexual transmission of classic Kaposi's sarcoma. To our knowledge, this is the first report of such a case. We noted a long delay between the probable contaminant contact and onset of lesions, suggesting that human herpesvirus 8 has longer incubation periods in healthy individuals than in immunocompromised patients.

[Phototoxic contact phytodermatitis: clinical and biological aspects]. / Phytodermatite phototoxique de contact: aspects clinique et biologique.

We report the case of a 39-year-old patient, gardener, who develops, during a beautiful sunny summerday, an erythemato-bullous eruption of the forearms. The diagnosis is a Contact Phototoxic Phytodermatitis (dermite des prés, dermatitis bullosa striata) with a classical presentation. This clinical observation gives us the opportunity to remind of the clinical and biological aspects of this dermatosis, whose frequency is probably underestimated, related to an often rapidly favourable evolution.

Carcinoma of the glans penis arising 20 years after lichen sclerosus.

Lichen sclerosis (LS) is an inflammatory disease of incompletely characterized pathogenesis. The relation between LS and carcinoma is well known in women, but in men it is still a matter of debate whether LS is a premalignant lesion or not. We describe a case of LS of the glans penis which occurred in 1976. Within the next 20 years, the patient developed carcinoma at this site.

Treatment of classical Kaposi's sarcoma with intralesional injections of cidofovir: report of a case.

The effect of intralesional injections of cidofovir, a nucleotide analog with potent in vitro activity against human herpesvirus 8 (HHV-8), was studied in vivo in an HIV-negative patient with classical Kaposi's sarcoma (KS). After five weekly injections of the drug, no clinical, histological, immunohistological, or virological changes could be detected in comparison with saline-injected lesions. These findings suggest that, once the KS tumor has developed, active viral replication is no longer involved in the pathogenesis of the disease. Alternative hypotheses are that HHV-8 replication in blood-borne cells may foster growth of spindle cells in the skin, or that blocking HHV-8 may not affect existing lesions but may prevent new lesions from developing.