[What is your diagnosis? A "fat arm". Onchocerciasis]. / Une histoire de "gros bras".

We report a case of edema of the right forearm with pruriginous papules and eosinophilia in the blood. The patient had lived in a forested area of Cameroon. The clinical, laboratory, and geographical findings led to a diagnosis of onchocerciasis, despite the absence of microfilaments on skin biopsy samples. The patient was successfully treated with ivermectin and doxycycline.

[Auto-inflammatory disease with hyperimmunoglobulinemia D of late onset]. / Maladie auto-inflammatoire avec hyper-IgD de révélation tardive.

BACKGROUND: The term "auto-inflammatory diseases" encompasses a group of disorders characterised by febrile episodes of sudden onset associated with joint, abdominal, lymph node and cutaneous signs, each presenting a genetic and/or laboratory specificity allowing their identification. Polyclonal elevation of serum IgD is highly suggestive of hyper-IgD syndrome, a disease with autosomal recessive transmission that usually begins before the age of one year. CASE REPORT: We report the case of a 46-year-old woman presenting a disease since the age of 30 years clinically very similar to hyper-IgD syndrome except for ocular and pulmonary involvement. However, tests revealed neither mevalonate kinase gene mutation nor elevation of urinary mevalonic acid. The near-monthly attacks were controlled with mycophenolate mofetil. DISCUSSION: Three cases with identical clinical and laboratory profiles have been reported in the literature and diagnosed as late-onset hyper-IgD syndrome. Our case is the only one involving indirect screening for mutation of the mevalonate kinase gene, which proved negative. This finding rules out the diagnosis of classic hyper-IgD syndrome in our case and raises the possibility of auto-inflammatory disease with reactional hyper-IgD of a different cause, either acquired or secondary to an as yet unidentified mutation.

A multi-component lattice Boltzmann scheme: towards the mesoscale simulation of blood flow.

While blood at the macroscopic scale is frequently treated as a continuum by techniques such as computational fluid dynamics, its mesoscale behaviour is not so well investigated or understood. At this scale, the deformability of each cell within the plasma is important and cannot be ignored. However there is currently a lack of efficient computational techniques able to simulate a large number of deformable particles such as blood cells. This paper addresses this problem and demonstrates the applicability of the authors' recent multi-component lattice Boltzmann method for the simulation of a large number of mutually immiscible liquid species [Dupin MM, Halliday I, Care CM. Multi-component lattice boltzmann equation for mesoscale blood flow. J Phys A: Math Gen 2003;36:8517-34]. In here, biological cells are treated as immiscible, deformable, and relatively viscous drops (compared to the surrounding fluid). The validation of the model is based on the work of Goldsmith on the flow of solid particles, deformable particles and red blood cells [Goldsmith HL, Marlow JC. Flow behavior of erythrocytes. II. Particle motions in concentrated suspensions of ghost cells. J Colloid Interf Sci 1979;71:383-407]. We demonstrate, in particular, that the model recovers Goldsmith's observations on the flow properties of red blood cells and also the experimental observations of Frank on the flow of solid beads [Frank M, Anderson D, Weeks ER, Morris JF. Particle migration in pressure-driven flow of a brownian suspension. J Fluid Mech 2003;493:363-78]. The current article is the first validation of our new lattice Boltzmann model for a large number of deformable particles in this context and demonstrates that the method provides a new, and effective, approach for the modeling of mesoscale blood flow.

[Impetigo herpetiformis and Ondine curse]. / Impétigo herpétiforme et syndrome d'Ondine.

INTRODUCTION: Impetigo herpetiformis is a rare dermatitis that occurs during pregnancy and may be life threatening for both mother and child. In this case report, we present an Ondine curse involving the baby, and the good response to isotretinoine. CASE REPORT: A first pregnancy, 26 year-old woman developed at 8 months a widespread skin lesion involving the medial side of the thighs, abdomen and intertriginous areas, with a severe systemic toxic condition and fever. Diagnosis of impetigo herpetiformis was made and corticosteroids, methotrexate and cyclosporine were unsuccessful. Isotretinoine rapidly improved the patient with good control of the disease. The full term baby had an Ondine curse. DISCUSSION: Our case is typical of impetigo herpetiformis. Maternal and infant complication may be life threatening and we report a real Ondine curse the etiology of which remains unknown. Moreover, this observation is unusual because the lesions did not clear despite delivery and good treatment. In our opinion, the great improvement with isotretinoine would suggest it could be used as first line treatment.

Cannabis arteritis.

The main causes of arteriopathy in young patients include drugs, metabolic diseases, pseudoxanthoma elasticum and Buerger's disease. Arteritis due to Cannabis indica was first reported in 1960, and the role of this drug as a risk factor for arteritis was confirmed in several subsequent publications. A 38-year-old smoker with no previous contributory medical history except for long-standing cannabis abuse developed a dry necrotic lesion of the left big toe. Imaging examinations revealed proximal arteriopathy of the lower limbs that predominated on the left side. He had no atherogenic or thrombogenic risk factors, and no signs of pseudoxanthoma elasticum were found. Remarkably, the development of arteritis paralleled cannabis abuse. The course was slowly favourable after weaning from the drug, vasodilator treatment and hyperbaric oxygen therapy. Despite some subtle clinical differences (more proximal than distal involvement), cannabis arteritis may be considered as a particular form of Buerger's disease, where cannabis, along with tobacco, seems to cause arterial lesions. Along with the noxious effects of cannabis on vessels, a role for contaminating arsenic is also possible. Cannabis arteritis is not widely known, but may prove not to be so rare if one considers consumption of cannabis besides that of tobacco.

A lattice Boltzmann model of flow blunting.

We review our recent multi-component lattice Boltzmann equation method for the simulation of a large number of mutually immiscible liquid species and then apply it to the simulation of dense volume fraction suspensions of deformable particles in internal geometry. In particular, we illustrate the scope of our method by applying it to the simulation of pipe flows containing a high volume fraction of monodisperse suspended, deformable particles. The particles are modelled as immiscible, relatively viscous liquid drops. We modify the 'solidity' of the particles by modifying their viscosity and surface tension and demonstrate the effect of the solidity upon the blunting of the velocity profile.

A many-component lattice Boltzmann equation simulation for transport of deformable particles.

We review the analysis of single and N-component lattice Boltzmann methods for fluid flow simulation. Results are presented for the emergent pressure field of a single phase incompressible liquid flowing over a backward-facing step, at moderate Reynolds Number, which is compared with the experimental data of Denham & Patrick (1974 Trans. IChE 52, 361-367). We then access the potential of the N-component method for transport of high volume fraction suspensions of deformable particles in pressure-driven flow. The latter are modelled as incompressible, closely packed liquid drops. We demonstrate the technique by investigating the particles' transverse migration in a uniform shear ('lift'), and profile blunting and chaining.

Capillary leak syndrome induced by acitretin.

The mucocutaneous side-effects of systemic retinoids are well known. We report a patient with diffuse oedema, which is a very rare side-effect of retinoids. The pathophysiology of this condition is poorly known because of the rarity of relevant observations, but apparently corresponds to capillary leak syndrome. The outcome is invariably favourable following withdrawal of the drug, which should be definitively contraindicated in the patient.

Functional melanonychia due to involvement of the nail matrix in systemic lupus erythematosus.

Longitudinal melanonychia is an unusual finding in systemic lupus erythematosus. We report the case of a patient of Arabic extraction with cutaneous lesions of lupus erythematosus on the cheek and chest and longitudinal melanonychia affecting several fingers. Results of histologic examination of the skin and direct immunofluorescence analysis confirmed the diagnosis of systemic lupus erythematosus. The distal matrix revealed changes suggestive of systemic lupus erythematosus accompanied by increased activity of melanocytes but without melanocytic hyperplasia. In this case, longitudinal melanonychia associated with systemic lupus erythematosus was of functional origin.

[Neuritic leprosy disclosed by reversal reaction]. / Neuropathie lépreuse révélée par une réaction de réversion.

We report a case of neuritic borderline tuberculoid leprosy with lingering insidious growth disclosed by a brutal reversal reaction. Inflammatory polyarthralgia and sensory and motor loss in the median and ulnar territories, without skin lesions, suggested vasculitis. A few weeks later, inflammatory skin lesions developed leading to the diagnosis of biopsy proven leprosy. Leprosy should be considered as a possible diagnosis in patients with multineuritis, especially when associated with rheumatic or cutaneous manifestations. Early skin biopsy in neuritic leprosy is discussed.

[Primary infection with West-Nile virus]. / Primo-infection à virus West-Nile.

BACKGROUND: The recent outbreak of an epidemic of West-Nile fever in New-York revealed this virus' responsibility in some cases of fatal encephalitis. However the clinical manifestations of the infection may be mild as in the case reported herein. CASE-REPORT: A 41-year-old woman without previous medical history presented an acute febrile rash after a trip to Senegal. The course was spontaneously favorable after 5 days, with a biphasic fever at day 3. Reverse passive hemagglutination test confirmed the diagnosis of acute West-Nile fever. DISCUSSION: West-Nile virus, a mosquito-borne flavivirus is usually responsible for a flue-like disease presenting a maculopapular rash in half of the cases. The biphasic evolution of fever is suggestive of the diagnosis. The diagnosis relies on serological tests but cross-reactivities with heterologous flaviviruses may render the interpretation difficult. A rapid recovery is usual but fatal meningoencephalitis can occur especially in the elderly. Treatment is supportive and prevention is limitation of human exposure. West-Nile virus is widely distributed (Africa, Asia, Middle East), but is also endemic in european areas and responsible for seasonal infections.

[Transformation of mycosis fungoides to pleomorphic T-cell lymphoma and central nervous system involvement]. / Mycosis fongoïde avec transformation en un lymphome cutané pléiomorphe et localisation secondaire cérébrale.

INTRODUCTION: Although mycosis fungoides is a malignant T-cell lymphoma involving mainly the skin, neurological complications are possible, with a poor prognosis. EXEGESIS: A 59-year-old man, treated for mycosis fungoides with transformation to a pleomorphic T-cell lymphoma for 1 year, was seen for mental status changes with confusion. A brain parenchyma localisation was found. CONCLUSION: This observation emphasizes the exceptional neurological tropism in the patients with mycosis fungoides. A transformation to a more aggressive cutaneous T-cell lymphoma seems necessary to induce a central nervous system involvement.

Neutrophilic eccrine hidradenitis secondary to infection with Serratia marcescens.

Neutrophilic eccrine hidradenitis (NEH) is a rare dermatosis which usually develops after administration of chemotherapeutic treatments. An infective origin is exceptional. We report a patient, previously operated on for ependymoma, who presented with an eruption typical of NEH even though he had not received chemotherapy. Culture of a skin biopsy revealed Serratia marcescens. The dermatosis improved after antibiotic therapy but recurred twice and culture again isolated S. marcescens; electron microscopy revealed cytoplasmic inclusions within neutrophils, suggestive of bacteria. The disease improved every time with appropriate antibiotic therapy. An infective aetiology for NEH is rare: three such cases have been reported, of which one was due to S. marcescens. The originality of our case is the recurrence of the disease on three occasions with the same bacterium isolated on each occasion, with disease remission after antibiotic therapy. This case confirms that infections may be a possible cause of NEH and underlines the necessity to search for infective agents, especially in patients immunocompromised by haematopoietic malignancies and/or chemotherapeutic treatments.

Erythema dyschromicum perstans: report of a new case and critical review of the literature.

Erythema dyschromicum perstans (EDP), described by Convit et al. in 1961, is a rare dermatosis. Its relationship with ashy dermatosis (AD), described by Ramirez in 1957, is still a matter of debate. We report a typical case of EDP. The patient, of North African origin, had a dyschromic (hypo- and hyperpigmented) eruption on the chest and limbs for 2 years. The lesions were occasionally surrounded by a papular border which spread slowly and centrifugally. Histological examination showed a lichenoid infiltrate. A carcinoma of the lung was simultaneously discovered. No treatment was given, EDP is infrequent and often considered identical to ashy dermatosis in the literature. However, the clinical aspects of the two diseases differ. The main features of these two diseases are reviewed and compared on the basis of a literature review. We conclude that EDP and AD are distinct clinical entities.

[African tick-bite rickettsiosis: the 1st case of autochthonous infection?]. / Rickettsiose à tique africaine: première contamination autochtone?

BACKGROUND: African tick-bite fever is caused by R. africae. All cases reported to date in France have occurred among patients who came from southern Africa, the endemic zone. We report the first case, to our knowledge, of a patient infected in France. CASE REPORT: A 69-year-old white man who had never left France developed fever and 3 "black spots" on the legs with lymphangitis and enlarged nodes. The clinically suspected diagnosis was confirmed by positive serology reactions to R. africae. As cross immunity with R. conorii can occur, the diagnosis was further confirmed by western blot for R. africae and by the persistence of the reaction after adsorption of the R. conorii serum. DISCUSSION: African tick-bite fever was identified as a clinical entity different from Mediterranean spotted fever by Kelly in 1992 who demonstrated the causal role of R. africae. The typical clinical presentation associates fever, several black spots, lymphangitis and multiple node enlargement. The serological diagnosis is difficult owing to cross immunity with R. conorii. Western blot and polymerase chain reaction are required for definitive diagnosis. In our case, the infection was probably due to a R. africae imported into France in the luggage of the patient's daughter who had spent 3 months in Zimbabwe.

[Infiltrating lipoma]. / Lipome infiltrant.

BACKGROUND: Deep or infiltrating lipoma is an often misdiagnosed clinical entity. We report two typical cases. CASE REPORTS: Two women, aged 92 and 62 years, were seen for a tumefaction on an upper limb with progressively increasing volume. The clinical presentation suggested deep lipoma, confirmed by magnetic resonance imaging and histology which eliminated liposarcoma, the main differential diagnosis. Surgical excision was successful. There has been no recurrence. DISCUSSION: These two observations recall the clinical, diagnostic and therapeutic features of infiltrating lipoma.