Acute generalized exanthematous pustulosis associated with pseudoephedrine.

Acute generalized exanthematous pustulosis (AGEP) is an uncommon skin disorder most often caused by drugs. Few adverse reactions to sympathomimetic drugs have been reported, despite their extensive use. Although the aetiology of AGEP remains uncertain, recent data have reported involvement of drug-specific T cells and interleukin (IL)-8 production. We characterized an adverse reaction to pseudoephedrine both clinically and immunologically. Histological analysis of skin biopsies confirmed the clinical entity as AGEP, while epicutaneous tests confirmed the specificity of the reaction to the drug. Moreover, immunohistochemical studies showed a mononuclear infiltrate consisting of activated memory T cells in addition to polymorphonuclear cells. Reverse transcription-polymerase chain reaction revealed an increased expression of IL-8 in AGEP-affected skin.

Erythema nodosum: etiologic and predictive factors in a defined population.

OBJECTIVE: To examine the frequency and features of erythema nodosum (EN), establish disease associations, and identify the optimal set of predictors for the occurrence of secondary EN. METHODS: We performed a retrospective study of an unselected population of patients 14 years and older with biopsy-proven EN diagnosed at a referral hospital between 1988 and 1997. Patients were classified as having either idiopathic EN or EN secondary to other diseases if the skin nodules occurred in the context of a well-defined disease, or if there was a precipitating event in close temporal proximity to the onset of EN. RESULTS: One hundred six patients (82 women) were diagnosed as having biopsy-proven EN. At the time of diagnosis, no precipitating events or underlying diseases were identified in 36.8% of patients. Sarcoidosis and nonstreptococcal upper respiratory tract infections (URI) were the most common conditions associated with secondary EN. Only 1 of 35 patients with an initial diagnosis of idiopathic EN and a followup of at least 1 year was finally diagnosed as having secondary EN. The best predictive model of secondary EN included an abnormal results on a chest radiograph, a previous history of nonstreptococcal URI, and a significant change in antistreptolysin O (ASO) titer in 2 consecutive determinations performed in a 2-4-week interval. Also, the presence of peripheral synovitis, a positive tuberculin skin test, and a history of diarrhea suggested the presence of secondary EN. This model showed high sensitivity and specificity. CONCLUSION: Idiopathic EN is common. A basic procedure including careful medical history-taking, a physical examination for peripheral synovitis, 2 consecutive ASO determinations, a tuberculin skin test, and chest radiography may be sufficient to diagnose EN.

[Secondary bladder melanoma. Report of a case concomitant with urothelial tumor of the bladder]. / Melanoma vesical secundario. A propósito de un caso coincidente con tumor urotelial de vejiga.

OBJECTIVES: To report on a case of melanoma, a rare tumor type metastatic to the bladder. METHOD/RESULTS: A case of melanoma metastatic to the bladder was incidentally discovered in a patient with urothelial cancer. The clinical features, diagnostic and therapeutic aspects are described. CONCLUSIONS: In a patient with malignant melanoma presenting irritative micturion syndrome and/or hematuria, endoscopic bladder exploration with multiple random biopsy must be performed to rule out melanoma metastatic to the bladder metastasis.