[Subacute meningococcaemia during adalimumab therapy]. / Méningococcémie subaiguë sous adalimumab.

INTRODUCTION: Subacute or chronic meningococcaemia is an invasive infection by Neisseria meningitidis characterized by fever lasting between a few days (subacute) and a week or more (chronic), cutaneous rash and arthralgia, without meningitis. PATIENTS AND METHODS: A 59-year-old woman was admitted for a fever with cutaneous rash. She had a history of Crohn's disease diagnosed in 2016 and treated with adalimumab for 14 months at a dosage of 40mg/week. For 3 days, she presented fever with a temperature of up to 40°C associated with a non-itchy erythematous-papular eruption on all four limbs, especially the lower limbs. The lesions were mildly painful on palpation. The rest of the clinical examination was unremarkable. The patient did not have arthralgia or neurological symptoms, and in particular, she exhibited no meningeal syndrome. Blood cultures as well as PCR on a skin biopsy specimen confirmed the diagnosis of meningococcaemia. The patient was treated with ceftriaxone 2g/day for 4 days then amoxicillin 12g/day for 4 days. A favourable outcome was quickly achieved, and the condition subsided without sequelae. DISCUSSION: We report the first case of subacute meningococcaemia in a patient treated with anti-TNF alpha therapy. This case concerns the role of biotherapies, and more particularly anti-TNF alpha therapy, in the occurrence of particular infections but also in changes in their clinical presentation and clinical course, as in the present case without arthralgia.

Late epidermal growth factor receptor inhibitor-related papulopustular rash: a distinct clinical entity.

We report four patients developing a late form of papulopustular rash induced by epidermal growth factor receptor inhibitors. These patients presented an unusual presentation of acneiform rash, characterized by late development (several months after treatment commenced), localization to the limbs with sparing of the face, and association with severe pruritus and Staphylococcus aureus superinfection in all cases. These clinical symptoms may suggest a distinct mechanism from the early acne-like rash frequently observed with these targeted anticancer therapies. Clinicians should be aware of this delayed adverse event, and we suggest the term 'late acneiform toxicity of EGFR inhibitors (LATE) syndrome' to permit better characterization of this clinical picture.

[Localized inflammatory alopecia of the scalp: an unusual presentation of tularemia]. / Plaque inflammatoire alopéciante du cuir chevelu : mode de révélation atypique d'une tularémie.

BACKGROUND: Tularaemia is a rare arthropod-borne zoonotic infection with 20 to 70 new cases being seen each year in France. Cutaneous ulceration and regional lymphadenopathy are the classical dermatological signs. Diagnosis of atypical forms is more complex. OBSERVATION: A 48-year-old woman was admitted for an erythematous papular alopecic lesion of the scalp accompanied by fever, chills and cervical lymphadenopathy. Initial antibiotic therapy for 20 days with amoxicillin clavulanate was ineffective. The patient's history included an episode of hunting in the forest three days before the onset of signs. Finally, serology led to the diagnosis of tularaemia. Combined levofloxacin and doxycycline resulted in regression of the scalp lesion and lymph node disorder. DISCUSSION: The existence of alopecia and location on the scalp did not initially suggest a diagnosis of tularaemia to us. The clinical presentation was highly suggestive of impetigo with satellite lymphadenopathies. However, resistance to antibiotics and the absence of inflammation militated against this diagnosis, and other possible diagnoses such as a tick-borne lymphadenopathy (TIBOLA), borreliosis and tularaemia were discussed. The most common clinical presentation of tularaemia is ulceroglandular tularaemia, which predominates in 80% of cases. The inoculation chancre at the point of initial infection is most often located in the upper limbs. CONCLUSION: An inflammatory plaque on the scalp with alopecia may reveal tularaemia, a potentially fatal disease resulting from inoculation.

Unusual location of an inoculation lesion in a traveler with African tick-bite fever returning from South Africa.

African tick-bite fever is a common tick-borne rickettsiosis in sub-Saharan Africa. It is an acute febrile illness associated with one (or more) inoculation eschar, an inconstant eruption, and local lymphadenopathies. We describe the first case of mucosal inoculation lesion on the vulva in a female traveler returning from South Africa.

Casos clínicos: Microsporum praecox y Acremonium strictum nuevos agentes de micosis cutáneas oportunistas en la zona central de Chile / Clinical reports: Microsporum praecox and Acremonium strictum new agents of opportunistic cutaneous mycoses in the central zone of Chile

Se presentan 2 casos clínicos de agentes de micosis cutáneas no descritos en el país. El primer caso corresponde a un paciente femenino de 18 años de edad, sin antecedentes mórbidos de importancia, ni viajes al exterior, que presenta una lesión pruriginosa en cara externa del brazo izquierdo de apariencia erito – pápulodescamativa de 2 semanas de evolución. Al examen directo, presentó micelios hialinos y en los cultivos micológicos un abundante desarrollo de Microsporum praecox. La lesión remitió completamente al tratamiento con Terbinafina tópica 2 veces al día por 21 días. Se comenta la rara presencia en Chile de M.praecox, especie presente en equinos y su hábitat, pero de dispersión restringida a Francia y Bélgica principalmente. Se discute el posible origen de este agente y las interrogantes en cuanto a su presencia en el país. El segundo caso corresponde a un paciente femenino de 24 años de edad, sin antecedentes mórbidos de importancia, que presenta alteraciones de la uña del primer ortejo derecho durante 2 años, caracterizadas por: engrosamiento subungueal, destrucción distal y cambios de coloración. Consulta con un dermatólogo, quien por su aspecto clínico típico, diagnostica onicomicosis e indica Terbinafina 250 mg diarios por 2 meses, sin embargo, el cuadro clínico se hace refractario en el tiempo frente a diversos antimicóticos usados.

Two clinical cases of agents of cutaneous mycoses not described in the country are reported in this paper. The first case deals with an 18-aged female patient, free from any significant morbid history, who has never traveled abroad, which bears a erytho-papule-descamative pruriginous lesion on the outside of her left arm and 2-week evolution. A direct exam revealed the presence of hyaline mycelia while an abundant development of Microsporum praecox was detected in the mycological cultures. The lesion had a favorable reaction to the treatment with topic Terbinafine twice a day for 21 days. The rare occurrence of M.praecox in Chile, a species commonly found in horses and their habitat yet with a restricted distribution mainly in France and Belgium and the possible origin of this agent in the country is commented. The second case is focused on a 24-age female patient, free from any significant morbid history, who exhibits variations in her first right toe since two years and which are characterized by the following: subungueal thickening, distal destruction and change in colour. She consults a dermatologist, who after considering a typical clinical aspect, determined an onimycosis and recommends 250mg Terbinafine for two months; however the clinical pattern becomes refractory in time due to the use of several antimycotic.

A rare cause of preseptal cellulitis: anthrax.

Infection of the eyelids confined to the preseptal space is relatively common but potentially serious. We report a child with cutaneous anthrax to remind that the interesting contagious cause be included in the differential diagnosis of the preseptal cellulitis.

Atypical manifestation of Vibrio vulnificus septicaemia.

Vibrio vulnificus is a Gram-negative marine bacterium that may cause local wound infection, gastroenteritis, or septicaemia. Fatal septicaemia usually presents with fever, shock, and large haemorrhagic bullae on the legs. This report is about a man who had severe V. vulnificus septicaemia but presented with atypical features of leg pain and diffuse purpuric skin lesions. V. vulnificus septicaemia should be suspected if the following are present: septic shock, leg pains associated with diffuse purpuric skin lesions, recent consumption of raw seafood, and a past medical history of liver cirrhosis.

Erupción maculopapulosa diseminada en un paciente con sida / Disseminated maculopapular rash in a patient with AIDS

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Foliculitis por Pseudomonas aeruginosa / Pseudomonas aeruginosa folliculitis

Pseudomonas aeruginosa puede producir una foliculitis debido a la utilización terapéutica o recreativa de jacuzzis, balnearios y ocasionalmente de piscinas. El cuadro se caracteriza por pústulas foliculares y pápulas inflamatorias que aparecen tras un período de incubación de dos a cuatro días y que mejoran espontáneamente en 7 a 10 días. Presentamos dos casos de foliculitis por Pseudomonas aeruginosa en dos hermanos (de 9 y 4 años) que ocurrieron tras dos días de baños en una pequeña piscina de vinilo. La dificultad en el control del crecimiento de Pseudomonas en jacuzzis, balnearios o piscinas obliga a un tratamiento adecuado de las aguas para prevenir esta foliculitis (AU)

Haemorrhagic papular rash associated to Flavimonas oryzihabitans bacteraemia in a child.

Flavimonas oryzihabitans is a gram-negative rod that has rarely been implicated in human infections. The involvement of this organism has been documented in serious infections, the majority of which were cases of bacteraemia or peritonitis. We report the first isolation of the organism in Greece, from a case of bacteraemia, associated with haemorrhagic papular rash, in a paediatric patient and describe the phenotypic characteristics of the strain.

Microscopic artifact found during examination of the skin: plant hair of Viburnum dentatum.

Examination of skin specimens with microscopic techniques requires differentiation of pathogenic structures from artifact. While preparing potassium hydroxide preparations for fungal identification or immersion oil preparations for scabies identification, we have recently seen several examples of a bizarre stellate or cruciform plant structure. These artifactual particles were identified as plant hairs from Viburnum dentatum, or arrowwood. Clinicians and laboratory technicians should be aware of this artifact in order to interpret microscopic skin specimens appropriately.

Papular-purpuric 'gloves and socks' syndrome: not only parvovirus B19.

We previously described an acute dermatosis characterized by pruritic erythematous and slightly papular lesions on the hands and feet in a 'gloves and socks' distribution associated with oral aphthoid lesions and fever (papular-purpuric 'gloves and socks' syndrome = PPGSS). We strongly suspected a viral origin, but serologic tests for a large panel of viruses remained negative. Subsequently, 2 cases of PPGSS with serologic evidence of a parvovirus B19 infection have been reported in the literature. Since then we observed 5 additional patients with a PPGSS. Parvovirus B19 infection could be confirmed in only 2 cases. Our findings suggest that the PPGSS can be another, yet undescribed manifestation of parvovirus infection. However, this cannot be shown in all the cases. As the papular acrodermatitis of childhood, this syndrome may be caused by various viral agents.