[Early signs of systemic disease in patients taking minocycline chlorhydrate]. / Symptômes évocateurs de maladie de système chez des patientes prenant du chlorhydrate de minocycline.

BACKGROUND: Search for etiology in young subjects with joint disease must take into consideration causes other than reactional arthropathy or systemic disease. CASE REPORTS: Two young subjects consulted for joint pain involving various joints. Physical examination did not reveal any other abnormality. Serum tests were positive for antinuclear antibodies and/or showed moderately and persistently elevated transaminases. History taking revealed that these subjects had been taking minocyclin chlorhydrate for several months, or even years, for acne. Joint pain subsided with drug withdrawal and serum tests returned to normal. DISCUSSION: Long-term treatment with minocylin chlorhydrate should always be included in the search for an etiology in patients presenting joint pain.

Juvenile dermatomyositis: treatment with intravenous gammaglobulin.

High-dose intravenous gammaglobulin (IVGG) has proved to be effective in the treatment of a number of immune disorders. We report two patients with juvenile dermatomyositis (DM) who improved with IVGG therapy. These patients had become refractory to corticosteroids and had developed unacceptable steroid toxicity. We suggest that IVGG can be useful in the treatment of juvenile DM, by reducing steroid requirements, and replacing immunosuppressive drugs.

[Photosensitization after intramuscular injections of hematoporphyrin. 3 cases]. / Photosensibilisation après injections intramusculaires d'hématoporphyrine. Trois cas.

Haematoporphyrin is a synthetic porphyrin the photosensitizing properties of which are used for the detection and treatment of some neoplasias. Three cases of phototoxicity from Hemedonine, an "anti-asthenia" drug composed of pure haematoporphyrin, are reported. Following exposure to the sun, painful urticarial plaques developed at the sites of intramuscular injections, and spread to the lumbar and abdominal regions, leaving a brownish pigmentation which persisted for years. Photobiological exploration was performed in one of these patients, demonstrating photosensitivity to Hemedonine in vivo and showing that long UVA rays were essentially responsible for the lesions. Histological examination elicited the initial vascular changes of a phototoxic reaction and suggested a new mechanism of photosensitization: "photo-induced immune vasculitis". The phototoxic effects of haematoporphyrin are primarily due to the destruction of intracellular organelles consecutive to oxidative denaturation of membrane systems. The initial phase of the phototoxic reaction might consist of complement activation and degranulation of dermal mast cells.