[Paget's extramammary disease of the axillae and perineum]. / Maladie de Paget des creux axillaires et de la région périnéo-inguinale.

INTRODUCTION: Paget's extramammary disease mostly affects genital, perianal and axillary regions. Whilst triple involvement has been described in Japanese patients, simultaneous lesions of both axillary regions and the inguinal area are exceptional among European patients. We report a case of triple Paget's extramammary disease in a Caucasian patient. CASE-REPORT: A 79-year-old male patient who developed a prostatic adenocarcinoma 3 years ago, was seen for an erythemato-squamous intertrigo of both axillary folds and the pubic area, present for 10 years, not diagnosed and resistant to topical treatments. Triple Paget's extramammary disease was confirmed by both histopathological and immunohistochemical investigations. No recurrence of the prostatic adenocarcinoma was observed. DISCUSSION: Since the first description of triple Paget's extramammary disease, 28 cases have been reported in Japan. To our knowledge, this is the first case observed in a Caucasian patient. The clinical features of axillary lesions are described as pigmented or depigmented plaques, sometimes lichenoid or erosive. For some Japanese authors, a biopsy is mandatory even in the absence of clinical lesions, since typical Paget cells can be found. Immunohistochemical studies reveal CK7 expression, the marker of choice for primary extramammary Paget's disease. CK7 - would suggest underlying regional internal malignancy as well as CK20 +. Despite the fact that the immunophenotype was CK7 +/CK20- the patient developed an evolving prostatic adenocarcinoma. Although various treatments are described in the literature, surgical excision remains the first line treatment whenever possible.

[Cutaneous acanthamoebiasis in a lung transplant patient]. / Acanthamibiase cutanée chez un transplanté pulmonaire.

BACKGROUND: Cutaneous acanthamoebiasis is a rare opportunistic infection in immunocompromised patients, particularly in HIV infected patients. We report a case of a primary cutaneous Acanthamoeba infection, in a patient with a double lung transplant not infected by the HIV. CASE REPORT: A 38 year-old white man, with a double lung transplant 3 years ago, developed a painful fibrinous ulceration of the right foot, with cellulitis. A few days later, two purplish nodules were observed, surrounded by an inflammatory reaction. Histologic examination revealed trophozoite and cyst forms. Therapy was begun with intravenous pentamidine and itraconazole along with topical ketoconazole and chlorhexidine, but was ineffective. Because of the renal toxicity of pentamidine, the patient was treated by dialysis. He died six months after diagnosis of Acanthamoeba infection. DISCUSSION: Acanthamoeba, a free-living amoeba is the causative organism of few human diseases. In immunocompromised hosts (particularly HIV infected), besides granulomatous amebic encephalitis, it can provoke some cutaneous lesions such as nodules, pustules, ulcerations... Skin biopsy is diagnostic: numerous amebic trophozoites and cysts are visualized. Recommended treatments are pentamidine, itraconazole and flucytosine. Due to the morbidity and mortality of acanthamoeba infection optimal therapy must be defined.