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Vedolizumab is a humanized monoclonal antibody that binds to the human a4β7 integrin and is approved for use in inflammatory bowel diseases. We describe a patient with severe, refractory erosive gingivostomatitis, which appeared a few days after the first dose of vedolizumab and resolved after discontinuation of the drug. We believe the gingivostomatitis to be a direct side effect of vedolizumab, rather than an extraintestinal manifestation of the underlying inflammatory bowel diseases. The clinicians need to be aware of this adverse event, which could be mistakenly considered as an extraintestinal manifestation of inflammatory bowel diseases.

Introduction L’inflammation des keratoses actiniques est recherchee par l’application topique de 5-fluorouracil, d’imiquimod ou de mebutate d’ingenol pour le traitement des champs de cancerisation des zones photo-exposees. Cependant, la reaction inflammatoire des keratoses actiniques secondaire a des traitements systemiques est moins connue. Nous en rapportons un cas en rapport avec un traitement par bendamustine. Observation Un homme de 78 ans etait traite par bendamustine pour une leucemie pro-lymphocytaire T. Il avait pour antecedents des keratoses actiniques traitees par imiquimod et 5-fluorouracil topique quelques annees auparavant, un carcinome epidermoide frontal gauche traite chirurgicalement, une hypertension arterielle et une hypercholesterolemie. Six jours apres la premiere cure apparaissait une eruption erythemato-keratosique des zones photos-exposees du visage et du cuir chevelu, correspondant cliniquement a une inflammation des keratoses actiniques. La biopsie cutanee montrait un epiderme inflammatoire, parakeratosique, atrophique et spongiotique, un œdeme du derme, un infiltrat lymphocytaire fait de cellules non atypiques ayant un tropisme vasculaire et une importante elastose actinique. Le diagnostic d’hematodermie etait ecarte par l’absence de composant monoclonal sur la biopsie ( Fig. 1 et 2 ). Discussion L’inflammation des keratoses actiniques secondaire a un traitement systemique a ete decrite pour la premiere fois en 1962, secondaire a l’injection de fluorouracil, puis avec la capecitabine, le paclitaxel, la doxorubicine, le cisplatine et le sorafenib. Toutes ces molecules sont des anti-cancereux, comme la bendamustine, et agiraient en induisant de facon selective la mort cellulaire des keratinocytes dysplasiques. Les reactions tres inflammatoires peuvent etre traitees par des dermocorticoides. Conclusion Nous presentons le premier cas d’inflammation des keratoses actiniques sous bendamustine. Cet effet indesirable ne doit pas etre confondu avec une allergie et ne doit pas mener a l’interruption du traitement anti-cancereux.

Background Post-excisional brachytherapy with Iridium 192 is a treatment of keloids scars (KS). Its indications and its parameters are not subject to any consensus. Objective We wanted to assess the effectiveness and satisfaction of patients treated in our centre. Patients and Methods This was a retrospective study conducted from November 2006 to November 2007. Patients with clinically and histologically proven KS treated between 1990 and 2005, were convened in consultation between September and October 2007. Clinical data and parameters of the brachytherapy have been collected. Results Eighty-seven patients (138 KS) were treated. Eighty-two KS (46 patients) met the criteria for inclusion. Thirty-two patients (55 KS) have been seen in consultation. The average time between the onset of KS and treatment was 63.5 months. The brachytherapy has begun after a maximum of 7 hours posterior to surgery for all KS. The average dose was 17.9 Gy calculated at 5 mm. We observed 23.6% of recurrence after treatment. Seventy-nine per cent of itching and 87.5% of pain have totally disappeared. The phototypes 5 and 6 had an increased risk of reccurence. Discussion This is the most important series of KS treated with Post-excisional brachytherapy presented so far. The technique is efficient in preventing keloid reccurence and in treating the functional signs, but at the expense of an unaesthetic result, of wich patient must be warned about. A follow-up of at least two years after treatment is recommended. Conflicts of interest None declared

In contrast with bone metastasis, acrometastases are uncommon and are associated with advanced cancer. We report the cases of two patients with atypical lesions of the fingers in a context of cancer, in which biopsies confirmed a metastasis. Patients died rapidly before treatment was initiated. We discuss the characteristics of these atypical metastatic sites, associated with a generally poor prognosis.

In contrast with bone metastasis, acrometastases are uncommon and are associated with advanced cancer. We report the cases of two patients with atypical lesions of the fingers in a context of cancer, in which biopsies confirmed a metastasis. Patients died rapidly before treatment was initiated. We discuss the characteristics of these atypical metastatic sites, associated with a generally poor prognosis.