[Incidence and characteristics of calciphylaxis in Martinique (2006-2012)]. / Incidence et caractéristiques de la calciphylaxie en Martinique (2006-2012).

BACKGROUND: Calciphylaxis is a rare and severe disease with an annual incidence of around 1 % in dialysis patients. The main study aim was to determine its incidence in Martinique, where there is a significant population of patients on dialysis. PATIENTS AND METHODS: All patients diagnosed with calciphylaxis between 2006 and 2012 and living in Martinique were included, retrospectively. Social, demographic, biological, anatomic, pathological, histological and outcome data were analysed. RESULTS: Fifteen patients were included (8 women, 7 men). The incidence of calciphylaxis in this population was about 4.62/1,000,000 inhabitants per year. All patients presented very painful skin ulcerations and necrosis, chiefly on the lower extremities in 53.3 % of cases. All patients were on haemodialysis and two had undergone renal transplantation. Fourteen of the 15 patients were presenting secondary hyperparathyroidism, 12 had hypertension, 9 peripheral arterial disease, 8 obesity and 8 diabetes mellitus. Raised calcium and phosphorus were noted in 8 patients, with hypoalbuminaemia in 9 patients. Treatment with sodium thiosulfate was given for 8 patients, and was beneficial for all after a mean duration of 3.4 months. After 6 months of follow-up, 8 of the 15 patients were cured, 1 showed improvement and 6 had died. CONCLUSION: To our knowledge, this is the first study to examine the incidence of calciphylaxis in the general population. The relatively large number of patients could be accounted for by the high number of comorbidities in end-stage renal disease patients in Martinique, including obesity, diabetes, hypertension and arteritis. Treatment with sodium thiosulfate was beneficial for 8 patients.

[Ulcerated nodular lesions on extremities of patient undergoing treatment for glioblastoma on French Caribbean island of Martinique]. / Lésions nodulaires et ulcérées des membres chez un Martiniquais traité pour un glioblastome. Phaéohyphomycose à Exophiala spinifera.

Phaeohyphomycosis comprises a disparate group of cutaneous and systemic mycotic infections caused by dematiaceous fungi. The Exophiala genus includes more than 20 species. The purpose of this report is to describe a case of phaeohyphomycosis due to Exophiala spinifera in a patient under treatment for cerebral glioblastoma on the French Caribbean island of Martinique. A 73-year-old man who was undergoing treatment for a cerebral glioblastoma using radiotherapy, chemotherapy and systemic corticosteroids presented with ulcerated nodular lesions on all four extremities for several months. Histological and mycological examinations led to diagnosis of cutaneous phaeohyphomycoseis due to Exophiala spinifera. Treatment using itraconazole was initiated but the patient died from complications of glioblastoma. Phaeohyphomycosis is a rare and cosmopolitan mycosis. Infection due to Exophiala spinifera is uncommon in humans. It usually but not always occurs in immunocompromised hosts. Although cutaneous involvement is usually localized and has a favorable prognosis, disseminated forms may occur and can be life-threatening. Histological and mycological examinations are useful to confirm the diagnosis. Systematic antifungals with or without surgical resection are often effective. To our knowledge, only 15 reported cases of phaeohyphomycosis due to Exophiala spinifera have been reported up to now.

[Confluent and reticulate papillomatosis of Gougerot and Carteaud: a retrospective study of 9 cases]. / Papillomatose confluente et réticulée de Gougerot et Carteaud: étude rétrospective de neuf cas.

BACKGROUND: Confluent and reticulate papillomatosis of Gougerot and Carteaud is a rare entity and a subject of controversy in terms of nosology. It has occasionally been regarded as a peculiar variant of acanthosis nigricans, pityriasis versicolor or amyloidosis. OBJECTIVES: To discuss confluent and reticulate papillomatosis and its diagnostic criteria as a distinct entity. METHODS: Retrospective study from 1994 to 2005 based on photographic files from 2 dermatology wards at the Saint Louis Hospital, Paris. Files containing a precise clinical description of the rash and at least one mycological element were included. RESULTS: Nine cases were included (6 females, 3 males). These patients showed clinical features comprising elementary lesion, distribution and topography corresponding to the classical description; histology was also consistent with confluent and reticulate papillomatosis, with no signs of amylosis and negative fungal samples or failure of antifungal treatment. One patient was presenting associated acanthosis nigricans. Doxycycline was efficacious in 4 cases in which it was evaluated. CONCLUSION: Confluent and reticulate papillomatosis is a definite entity and is not a superficial fungal disease. It must be distinguished from pityriasis versicolor as well as acanthosis nigricans and cutaneous amyloidosis. The therapeutic efficacy of oral cyclines (doxycycline or minocycline) appears to be an important distinguishing feature that can serve as a diagnostic criterion.