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Objectives: Familial Mediterranean fever (FMF) is the most frequent monogenic autoinflammatory disease. It is associated with MEFV mutations. Its main features are recurrent episodes of fever and serositis. Patients can display dermatological manifestations such as erysipelas-like erythema, generally considered as a neutrophilic dermatosis (ND). It has been suggested that FMF can be associated with other types of ND. Our aim was to perform a systematic review of the literature to assess the link between ND and FMF.Method: A systematic review of the literature was performed using MEDLINE from 1946 to 2018. Three independent investigators identified reports of non-erysipelas-like erythema neutrophilic dermatosis (NEND) associated with FMF, selected the criteria to establish the diagnosis of FMF and ND, and evaluated the link between the two conditions. FMF-associated NEND was supported by confirmation of both diagnoses and exclusion of other causes of ND.Results: Eighteen articles were selected. Nine articles reported FMF patients with the following NEND: neutrophilic panniculitis (n = 4), Sweet syndrome (n = 6), and pyoderma gangrenosum (n = 1). None of these cases was supported by histological confirmation, fulfilled diagnostic criteria for definitive or probable FMF, or confirmed the exclusion of all the most frequent diseases associated with NEND. As a result, there is insufficient evidence to support a potential relationship between NEND and FMF.Conclusions: The association between FMF and NEND remains unclear. In FMF patients with NEND, every differential diagnosis and alternative cause of NEND should be excluded before drawing any conclusions about a potential causal relationship.

Resume Introduction La brucellose est rare en France et la diversite des tableaux cliniques peut parfois poser un probleme diagnostique. Observation Nous rapportons l’observation d’une femme de 76 ans d’origine tunisienne adressee pour asthenie, amaigrissement, fievre intermittente et douleurs de l’hypochondre droit, associes a des lesions hepatiques ayant fait evoquer des lesions malignes au scanner, a l’IRM et au TEP-scan. Cependant, les hemocultures positives a Brucella melitensis permettaient de poser le diagnostic de brucellomes hepatiques. Conclusion Les abces hepatiques sont rares au cours de la brucellose. Cette infection doit etre evoquee chez les patients de retour de zone d’endemie, meme devant des manifestations atypiques.

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SummaryBackground Leg ulcers (LUs) are a chronic and severe complication of sickle cell disease (SCD). A prospective study in patients with SCD to identify factors associated with complete healing and recurrence of LUs is lacking. Objectives To determine clinical and biological factors associated with SCD-LU complete healing and recurrence. Methods This prospective, observational cohort study was conducted at two adult SCD referral-centre sites (2009–2015) and included 98 consecutive patients with at least one LU lasting ≥ 2 weeks. The primary end points compared patients with healed vs. nonhealed LUs at week 24, and patients with vs. without recurrence during follow-up. Results The median (interquartile range) LU area, duration and follow-up were, respectively, 6·2 cm2 (3–12·8), 9 weeks (4–26) and 65·8 weeks (23·8–122·1). At week 24, LUs were healed in 47% of patients, while 49% of LUs recurred. Univariate analyses identified inclusion LU area < 8 cm2 (82% vs. 35%; P < 0·001), inclusion LU duration < 9 weeks (65% vs. 35%; P = 0·0013) and high median fetal haemoglobin level (P = 0·008) as being significantly associated with complete healing at week 24, and low lactate dehydrogenase level (P = 0·038) as being associated with recurrence. Multivariate analyses retained LU area < 8 cm2 (odds ratio 6·73, 95% confidence interval 2·35–19. 31; P < 0·001) and < 9 weeks’ duration (OR 3·19, 95% confidence interval 1·16–8·76; P = 0·024) as being independently associated with healing at week 24. Factors independently associated with recurrence could not be identified. Conclusions SCD-LU complete healing is independently associated with the clinical characteristics of LUs rather than the clinical or biological characteristics of SCD.

The epidermal growth factor receptors (EGFR)-inhibitors are frequently responsible for cutaneous adverse drug reactions that may alter the patients' quality of life and hamper the continuation of treatment. We present here the experience of a group of French multidisciplinary experts - the PROCUR group (PRise en charge de la tOxicite CUtanee des anti-EGFR) - created in order to establish a therapeutic algorithm. It was built in three steps under the responsibility of a steering committee: (1) a systematic literature review was performed by a group of three dermatologists and one oncologist; (2) regional meetings evaluated practical aspect of the treatments in France; (3) a final meeting confrontating the practices in France and the evidence-based medicine including the steering committee, the bibliographic group, and oncologists, radiotherapists, dermatologists and hepato-gastroenterologists involved in regional scientific committees, resulted in a therapeutic algorithm, resulting in the collegial writing of this algorithm. This multidisciplinary study should facilitate the standardised, optimised management of skin toxicity associated with EGFR-inhibitors.

Cutaneous adverse events induced by epidermal growth factor receptor (EGFR) inhibitors can hamper the patients' quality of life. The aim of our work was to draft an algorithm for the optimised management of this skin toxicity.This algorithm was built in three steps under the responsibility of a steering committee. Step I: a systematic literature analysis (SLA) has been performed. Step II: the collection of information about practices was performed through a questionnaire.These questions were asked during regional meetings to which oncologists, gastro-enterologists, radiotherapists, and dermatologists were invited. Step III: a final meeting was organised involving the bibliography group and the steering committee and regional scientific committees for proposing a final algorithm.Step I: 14 publications were selected to evaluate the use of cyclines as curative or prophylactic treatment of the folliculitis induced by EGFR inhibitors. Nineteen publications were retained for the topical treatment of the folliculitis. Forty-six articles were selected for the management of the cutaneous lesions in link with appendages and 12 for xerosis and pruritus. Step II: 96 delegates attended the seven regional meetings and 67 questionnaires were analysed. Step III: a final algorithm was proposed on the basis of the conclusions of the first two steps and expert opinions present at this final meeting. The different propositions were unanimously approved by the 14 experts who voted.This multidisciplinary study summarising published data and current practices produced a therapeutic algorithm, which should facilitate the standardised, optimised management of skin toxicity associated with EGFR inhibitors in France.

Advances in the understanding of the mechanisms involved in oncogenesis have led to the development of so-called targeted therapies such as epidermal growth factor receptor (EGFR) inhibitors, which take on an increasingly important role in the management of cancer. These treatments have the advantage not to trigger the adverse effects traditionally encountered with chemotherapy, such as nausea, vomiting or haematological toxicity. However, they do cause new forms of toxicity: the most common one is skin toxicity. It is important to be aware of it because it can be debilitating, adversely impacting patients’ quality of life and altering treatment compliance, although it appears to be correlated with treatment response in certain series. Non-specialists can have difficulty in recognising this unusual skin toxicity. The dermatologic side effects most frequently triggered by EGFR inhibitors are discussed in this article. They are divided into three categories depending on their target: inflammation of the pilo-sebaceous follicle, represented by EGFR inhibitor-associated folliculitis, which occurs at an early stage and is frequent; alteration in the skin barrier, primarily responsible for xerosis, fissures and pruritus, which are frequent and delayed; and lesions of the skin appendages (paronychia, pyogenic granuloma, hair changes), which are delayed and less frequent. It is essential for all practitioners concerned to know about these dermatologic side effects in order to ensure better global management of patients, particularly in terms of quality of life.

Background Epidermal growth factor receptor (EGFR) inhibitors are part of the therapeutic arsenal available for advanced cancer. However, they are frequently associated with cutaneous side-effects, which can hamper compliance, lead to treatment refusal and impair quality of life. Objective To know the attitudes of French oncologists who deal with this skin toxicity. This work is one of the steps to build a therapeutic algorithm of side-effects induced by EGFR inhibitors taking both evidence-based medicine and standard practices into account. Methods Physicians completed a questionnaire as part of regional meetings, before any discussion. Questions concerned the management of 11 clinical situations in the context of EGFR inhibitor prescription. Results Sixty-seven questionnaires were analysed. The collaboration with dermatologists was especially planned for persisting or worsening lesions beyond 2 weeks, but never considered at the time of the introduction of targeted therapy. The results demonstrated the difficulties encountered in diagnosing and grading skin lesions. Attitudes of oncologists were uniform for preventive care and management of mild lesions for which moisturizing and cyclines were widely prescribed. Significant differences appeared in the treatment of less typical cases such as the involvement of skin appendages, secondary infections of folliculitis or cases associated with radiodermatitis. Discrepancies existed also for what to do in relation with maintenance or interruption of EGFR inhibitor mainly if they were responsible for severe lesions. Conclusion This original survey emphasizes the interest of greater multidisciplinary collaboration and the necessity to harmonize practice.

Objective Kawasaki disease (KD) is a vasculitis that mostly occurs in young children and rarely in adults. We analyzed the characteristics of adult-onset KD (AKD) in France. Methods We collected retrospective and prospective data for patients with a diagnosis of KD occurring after the age of 18 years. Cases were obtained via various French medical networks and identified from the international literature. Results We included 43 patients of AKD at 26 institution from 1992 to 2015, with mean (SD) age 30 (11) years (range 18–68) and sex ratio (M/F) 1.2; 34 patients met the American Heart Association criteria and 9 were incomplete AKD. The median time to diagnosis was 13 days (interquartile range 8–21). The main symptoms were fever (100%), exanthema (98%), changes in the extremities (91%), conjunctivitis (77%), oral cavity changes (89%), cervical adenitis (55%) and cardiac abnormalities (45%). Overall, 35% of patients showed large-vessel vasculitis: coronary vasculitis (26%) and coronary aneurysm (19%). Treatment was mostly intravenous immunoglobulins (79%) and aspirin (81%). Four patients showed myocardial infarction due to coronary vasculitis, but none were treated with IVIg because of late diagnosis. After a median follow-up of 5 months (range 1–117), persistent aneurysm was noted in 9% of cases. Damage was significantly lower with early treatment than late or no treatment (p = 0.01). Conclusion Given the high frequency of cardiac involvement and complications in this series of AKD, diagnosis and treatment should not be delayed, and early IVIg treatment seems to improve the outcome

Resume Introduction Le syndrome de Good est caracterise par l’association d’un thymome a une hypogammaglobulinemie, une lymphopenie B circulante, et de maniere variable, une lymphopenie T CD4 circulante avec un rapport CD4/CD8 inverse, s’accompagnant d’infections et de maladies auto-immunes. Observation Nous rapportons l’observation d’une femme de 85 ans qui presentait un lichen plan buccal erosif associe a un syndrome de Good. L’amelioration des lesions buccales etait observee apres l’exerese du thymome benin, alors que le deficit immunitaire persistait. Seulement 11 observations associant un syndrome de Good et un lichen plan ont ete precedemment rapportees dans la litterature. Conclusion L’association d’un lichen plan buccal erosif a un syndrome de Good est rare, mais ne parait pas fortuite.

Summary Background Leg ulcers are a poorly known and underestimated complication of sickle cell disease (SCD), but in our experience they often appear as a severely disabling condition, associated with the most severe forms of the disease. Objectives To assess the characteristics, complications, repercussion on quality of life and associations of SCD ulcers. Methods Case series of 20 patients followed in a French referral centre for SCD and who had previous/present leg ulcers. Results Median ulcerated area was 12 cm² and median time spent with ulcers was 29·5 months. Locoregional infections developed in 85%, ankle stiffness in 50% and mood disorders in 85%. Ninety per cent of patients needed analgesics, 20% being opioids. Median loss of time from work was 12·5 months. The Short Form 36 Health Survey showed physical and mental component summary scores of 41·5 and 40·7, respectively, indicating severe alteration close to that found in lung cancer or haemodialysis. Two categories of SCD leg ulcers were distinguished, defined by a 1-year duration cut off. The ‘prolonged’ ulcers had larger surfaces, tended to recur more frequently and led to more infection and depression. Several SCD complications were associated with leg ulcers, notably priapism, pulmonary hypertension, stroke and acute chest syndrome. Conclusions Leg ulcers are a major complication of SCD, given their severe consequences and frequent association with other specific organ damage, and they constitute in their ‘prolonged’ form a severely disabling condition that remains an important therapeutic challenge.

Resume Introduction Le carcinome epidermoide cutane est une tumeur infiltrante et destructrice, qui peut etre letale par l’extension locale ou la survenue de metastases. Nous rapportons un cas de carcinome epidermoide geant du nez avec une extension cerebrale et discutons les principaux facteurs de risque de cette extension. Observation Un homme de 45 ans etait opere d’un carcinome epidermoide geant du nez, apres radiotherapie de reduction. L’examen histologique montrait une tumeur bien differenciee, et un envahissement perinerveux, avec des marges d’au moins 6 mm. Une premiere rechute survenait sur le bord de l’exerese initiale vers l’orbite gauche, necessitant une reprise chirurgicale qui objectivait une atteinte du nerf sous-orbitaire gauche. Sous chimiotherapie, une seconde rechute se traduisait par une ophtalmoplegie et une cecite de l’œil gauche avec une atteinte de l’apex orbitaire, du sinus caverneux et du lobe temporal. Le malade decedait d’un etat de mal epileptique. Discussion L’extension cerebrale des carcinomes epidermoides cutanes de la tete est rare. Elle se fait le long des voies anatomiques et en particulier le long des filets nerveux. Les principaux facteurs de risque pour cette evolution defavorable sont discutes, en particulier la taille initiale de la lesion, le siege, l’epaisseur et l’envahissement perinerveux.

Essential thrombocythemia is a myeloproliferative disorder responsible for both hemorrhagic and thrombotic complications mostly venous but also arterial, especially of the microcirculation. We report a 64-year-old female who presented with an aortic thrombus and splenic infarcts indicating essential thrombocythemia. Outcome was favourable with medical treatment combining low-molecular-weight heparin secondarily switched to warfarin, associated with aspirin and hydroxyurea.

Resume La survie des patients ayant un lymphome de Hodgkin s’est nettement amelioree ces dernieres annees, avec cependant une augmentation des complications tardives, en particulier neoplasiques. Nous rapportons l’observation d’un patient ayant presente une rechute d’un lymphome de Hodgkin classique concomitante a la decouverte d’un adenocarcinome bronchique, 20 ans apres la prise en charge initiale par chimiotherapie de type Mopp et radiotherapie en mantelet. Les mecanismes physiopathologiques de ces complications sont discutes. Une surveillance prolongee est necessaire chez tous les patients ayant un lymphome de Hodgkin.

A 53-year-old man with a history of bilateral cataract surgery at the age of 32 years with ‘a negative work-up’ and no family history was referred for fatigue, intermittent fever, night sweats and cough for the last 2 months. At examination, he appeared fatigued and febrile (38.6°C). He also complained with perioral and limb paresthesiae, and muscles cramps of recent onset. Trousseau and Chvostek signs were both present. Blood cell count showed a hemoglobin level of 8.6 g/dl with a mean corpuscular volume of 73 fl and 54 000 reticulocytes/mm3, a white blood cell count of 6100/mm3 with 73% neutrophils and 15% lymphocytes and the platelet count was 363 000/mm3. Immunophenotyping of lymphoid cells showed 738 CD4+ cell/mm3 and 276 CD8+ cell/mm3 and a normal level at 9% of CD25+ CD127 low/reg of CD4 cell count. Human immunodeficiency virus testing was negative. Serum creatinine and liver function tests were normal, serum albumin was 32.8 g/l (normal 39–46 g/l). Serum total calcium level was 1.07 mmol/l (normal 2.16–2.52 mmol/l) and phosphate level 1.44 mmol/l (normal 0.85–1.31 mmol/l). A further evaluation of calcium homeostasis was performed showing: serum ionized calcium …

The development of several types of autoimmune disorders is well known in the course of B-cell lymphoproliferative diseases. In order to investigate whether these autoimmune diseases may target cutaneous antigens, especially those of the dermal-epidermal junction, we conducted a retrospective analysis of all cutaneous direct immunofluorescence studies performed in patients with B-cell neoplasia who presented with cutaneous lesions requiring a skin biopsy. Patients with linear deposits of immunoglobulin or C3 molecules at the dermal-epidermal junction were studied further, using immunoblotting and immunoelectron microscopy. Patients with no overt hematologic malignancies but with cutaneous lesions requiring direct immunofluorescence were studied as a control population. During the study period, the diagnosis of autoimmune blistering diseases of the dermal-epidermal junction was established in 9/102 (8.9% +/- 2%) patients with a B-cell lymphoid disorder, compared with 288/8,189 (3.5% +/- 0.04%) patients without underlying hemopathy (p < 0.01). Among the 9 patients, 7 were studied in detail. Immunologic studies demonstrated epidermolysis bullosa acquisita in 6 patients and cicatricial pemphigoid in 1. Autoimmune blistering diseases, especially epidermolysis bullosa acquisita, are part of the spectrum of autoimmune disorders associated with B-cell neoplasia.

Congenital toxoplasmosis usually results from acquired infection in non-immune pregnant women. However, severely HIV-infected women with a latent Toxoplasma infection can transmit the parasite as a result of reactivation. We report a case of toxoplasmic reactivation in an HIV-infected woman with moderate immunosuppression resulting in a severe congenital toxoplasmosis.

We report nine cases of haemophagocytic syndrome (HS) in patients with human immunodeficiency virus infection, and review the 17 cases described to date in the literature. In 21 of 26 cases, HS developed during an advanced stage of immunodeficiency. Clinical and haematological signs are not specific in this setting, and the diagnosis relies on histological features, mainly bone marrow examination. An opportunistic infection was associated in three cases and a lymphoid malignancy in two of our nine cases. The role of the human immunodeficiency virus in the occurrence of the HS remains to be defined. The overall prognosis is poor as six of our nine patients died within 12 months of presentation.

Resume La primo-infection symptomatique (PIS) par le virus de l'immunodeficience humaine (VIH) a ete initialement decrite comme un syndrome mononucleosique associe a une meningite lymphocytaire, survenant au cours de la seroconversion. Cependant, les manifestations cliniques depassent ce cadre originel, conduisant a evoquer le diagnostic devant tout syndrome infectieux d'installation brutale chez un patient presentant des facteurs de risque pour le VIH et, par consequent, a rechercher l'antigenemie p24 et l'apparition des anticorps diriges contre le VIH. L'intensite de l'expression clinique de cette phase precoce pourrait etre un indicateur de l'evolution de l'infection par le VIH. Ainsi, elle est dans de nombreuses etudes un facteur pronostique pejoratif de la maladie. Les mecanismes pathogeniques font intervenir des facteurs inherents a l'hote et au virus. Une intervention therapeutique precoce pourrait modifier le cours evolutif de la maladie.

Gram-negative folliculitis usually involves the face and develops in patients with acne or rosacea during long-term antibiotic therapy. Numerous pathogens have been found, but not, until now, Acinetobacter baumanii which has previously been recognized as an important cause of nosocomial infections and hospital outbreaks. We report here a case of A. baumanii folliculitis of the face, neck, arms and upper part of trunk in a patient with AIDS responding to intravenous treatment with ticarcillin-clavulanic acid. The bacterium was not found on healthy skin and the source of the infection remained unknown.

Background: Early diagnosis of leukemia cutis in myelodysplastic syndrome (MDS) is important because these lesions can precede acute peripheral blood or bone marrow transformation. Leukemia cutis is usually easy to recognize, but atypical lesions are not well described. Objective: Our purpose was to describe unusual specific lesions in MDS. Methods: Data from patients with myeloid malignancies and leukemia cutis were reviewed. Only patients with MDS and cutaneous lesions different from typical tumors were included. Clinical features were analyzed. Results: Four patients with MDS and unusual specific cutaneous lesions were found. They had ecchymoses, necrotic plaques or ulcers, and prurigo-like lesions. In three of four patients appearance of these skin lesions heralded or was concomitant with acute transformation. Conclusion: Specific cutaneous lesions can dislay unusual patterns. Early biopsy of cutaneous lesions in MDS is indicated.

To determine the influence of neurologic manifestations of primary human immunodeficiency virus (HIV) infection on disease progression, 277 nonhemophiliac adults enrolled < 1 year after HIV infection were studied. Patients with neurologic manifestations during symptomatic primary HIV infection (PSI) (group N+; n = 23), with nonneurologic manifestations (group N-; n = 112) during PSI, and without any clinical manifestation during primary infection (group NPI; n = 142) were compared for disease progression. Age at infection, sex, mode of infection and CD4+ cell count at first visit did not differ between groups. In a Cox model, the relative risk (RR) of developing AIDS was 6.11 (95% confidence interval [CI], 1.94-19.28) in group N+ and 2.32 (95% CI, 0.93-5.83) in group N- compared with group NPI. The RR of AIDS onset after adjustment for treatment and age at infection was, respectively, 4.65 (95% CI, 1.43-15.03) and 2.03 (95% CI, 0.80-5.19) in groups N+ and N-. Neurologic manifestations of primary HIV infection are associated with an accelerated progression of disease.

Introduction. Folliculitis is the most common side effect of epidermal growth factor receptor (EGFR) inhibitors (EGFRIs). It is often apparent, altering patients' quality of life and possibly impacting compliance. Variations in terms of the treatment-related incidence and intensity have not been fully elucidated. Tetracyclines have been recommended for the prophylaxis and treatment of folliculitis but their efficacy is yet to be established. Materials and Methods. We carried out two systematic literature reviews. The first assessed the preventive and curative efficacy of tetracyclines. The second assessed the incidence of grade 3–4 folliculitis in the main clinical studies published. Results. In four randomized studies, preventive tetracycline treatment was associated with a significantly lower incidence of grade 2–3 folliculitis and a better quality of life in three of the four studies. In curative terms, tetracycline efficacy was not evaluated in any randomized study, but an improvement in grade ≥2 folliculitis was reported in case series. The frequency and severity of folliculitis seem to be greater with the antibodies than with the tyrosine kinase inhibitors. Analysis restricted to lung cancer studies showed a statistically greater incidence in terms of grade 3–4 folliculitis with cetuximab (9%) and erlotinib (8%) than with gefitinib (2%) (p < .0001). Conclusion. Unless contraindicated, a tetracycline should be routinely prescribed prophylactically for patients treated with an EGFRI (level of evidence, B2). In curative therapy, the level of evidence for tetracycline efficacy is low (level of evidence, D). The incidence of grade 3–4 folliculitis induced by EGFRIs appears to be lower with gefitinib.

Fever is often present during painful vaso-occlusive crisis (VOC) in sickle-cell disease (SCD), but does not always indicate infection. The aim of our study was to test procalcitonin as a marker of invasive bacterial infection in VOC. Consecutive SCD adults hospitalized for VOC were included. Data were collected at admission and within 24 h after the onset of fever. We distinguished patients with clinically defined and microbiologically documented invasive bacterial infection from patients with no evidence of invasive bacterial infection and who fared well without antibiotics. One hundred and twelve patients were enrolled (61% females, median age 23 years, 88% homozygous SCD). All patients with procalcitonin (PCT) level ≥1 μg/L had an invasive bacterial infection, but two patients (33%) with an invasive bacterial infection had a PCT level

A software product-line is a set of products built from a core set of software components. Although software engineers develop software product-lines for various application types, they are most commonly used for embedded systems development, where the variability of hardware features requires variability in the supporting firmware. Feature models are used to represent the variability in these software product-lines. Various feature modeling approaches have been proposed, including feature diagrams, domain specific languages, constraint languages, and the semantic web language OWL. This paper explores a conceptual graph approach to feature modeling in an effort to produce feature models that have a more natural, and more easily expressed mapping to the problem domain. It demonstrates the approach using a standard Graph Product-line problem that has been discussed in various software product-line papers. A conceptual graph feature model is developed for the graph product-line and it is compared to other feature models for this product-line.

Familial Mediterranean fever (FMF) is the most frequent monogenic autoinflammatory disease (AID). Hidradenitis suppurativa (HS) is an inflammatory skin disease characterized by recurrent abscesses and scarring in apocrine gland-bearing areas. HS shares common features with AID including a positive correlation between the increase of acute phase reactants (APR) and the severity of the disease. HS can be associated with other AID.

Pachydermoperiostosis (idiopathic or primary hypertrophic osteoarthropathy) is a rare condition of unknown origin involving the skin and the skeleton, with an autosomal dominant transmission. We report a case of anaemia in a patient with pachydermoperiostosis indicating myelofibrosis, and review the literature and the pathogenetic mechanisms.

Recently, increased rates of syphilis among gay men have been observed in American and European cities. It is important to establish the diagnosis because syphilis facilitates HIV transmission during the primary and secondary stages when sores are open on the skin. However the diagnosis can present a dilemma as negative reactions to serological tests may be observed in AIDS patients. We report here such a case in which the diagnosis was established on dark field examination.

We report two patients treated with interferon-alpha who developed Raynaud's phenomenon followed by multiple digital necrosis. Arteriography of the legs revealed diffuse distal narrowing. Histological examination of the resected tissue showed ischaemic necrosis within the dermis and subcutaneous tissue without vasculitis. Resolution of the symptoms was observed when interferon-alpha was withdrawn. Since other causes of Raynaud's phenomenon and digital necrosis were ruled out, a drug cause is likely. Raynaud's phenomenon should be looked for in patients treated with interferon-alpha. If present, immediate withdrawal of the drug is required.

We describe a case of neurologic manifestations including coma, convulsion and eye movement disorders, associated with hypomagnesemia and hypocalcemia in a patient treated with cisplatin for an ovarian adenocarcinoma. Pathophysiological mechanisms involve renal tubular damage leading to renal magnesium wasting and related hypocalcemia.

We report the case of a 23 year-old Caribbean woman with sarcoidosis who developed specific skin ulcerations. Ulcerative lesions in sarcoidosis are distinctly unusual, generally multiple, painless, with preponderant location on the lower limbs. The diagnosis is difficult. The pathogenesis is discussed. The most successful therapy is hydrochloroquine with corticosteroids.

Neutrophilic eccrine hidradenitis (NEH) is a recently described disease characterized by the presence of a cutaneous aseptic infiltrate of polymorphonuclear neutrophils, whose peculiar feature is linked to the elective disposition of the infiltrate around eccrine coils and glands. This condition has been initially and until now mainly reported in patients receiving chemotherapy regimens for acute myelogenous leukemia (AML), leading some investigators to hypothesize that NEH could represent a peculiar reaction to cytotoxic drugs excreted in sweat. The description of cases occurring before the diagnosis of the hemopathy, of cases in individuals treated with granulocyte colony-stimulating factor (G-CSF) or even of patients with other malignancies, suggests that NEH may rather be— closely to Sweet’s syndrome—a part of the spectrum of neutrophilic diseases. To the best of our knowledge, 51 cases of NEH have been reported in the literature to date. Clinical and histological features of these cases are reviewed and pathogenesis is discussed.

Two cases of severe hepatitis in young women using Atrium and paroxetine are presented. Both patients presented jaundice, marked increase in aminotransferases activities, and pronounced prolongation in prothrombin time. In both cases, liver biopsy specimen examination revealed lesions compatible with drug-related injury. Other causes of hepatic injury were reasonably ruled out by complete careful screening. Outcome was marked by rapid complete recovery in one case and by slow recovery in the other. We suggest that simultaneous treatment with Atrium and paroxetine could increase each of these drugs' hepatotoxicity.