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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.

Actinomycosis is a chronic and extensive granulomatous, bacterial infection. Revelation by oral ulceration is rare.A 76-year-old patient with diabetes was treated with dabrafenib for stage IV melanoma. A follow-up visit revealed two ulcerated, infiltrated and hyperalgesic lesions of the palate and gingiva. There were no associated signs. The laboratory findings were normal. The possibility of squamous cell carcinoma occurring with BRAF inhibitors was discussed, despite the rarity of such cases in the literature. Histological examination showed an actinomycotic grain. A scan of the facial mass showed no osteitis. Antimicrobial therapy was initiated with amoxicillin for four months, with a favorable outcome.Actinomycetes are Gram-positive filamentous saprophytic bacteria of the oral cavity and the gastrointestinal tract. They can become pathogenic under the influence of several factors. Cervicofacial involvement in the form of a peri-mandibular inflammatory nodule with secondary fistulation on the skin or in the mouth is the classic presentation. To our knowledge, no cases of opportunistic infection under BRAF inhibitors have been described. Only two cases of tuberculosis have been reported with sorafenib. The initial presentation led to suspicion of squamous cell carcinoma. In our patient, poor oral hygiene and diabetes were the two key factors considered. Moreover, this is the first case reported under dabrafenib, which does not appear to be a favoring factor. We would stress the importance of mucosal examination in patients treated with BRAF inhibitors.

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.

Gonadorelin (LH-RH) analogues are used in urology, gynaecology and paediatrics. Sterile abscesses sometimes occur at the injection site although the underlying mechanism is poorly understood.A 72 year-old man presented weeping ulceration of the right buttock several days after the 9th intramuscular injection of an LH-RH analogue (leuprorelin SR 11.25 mg) for prostate cancer. There was no local reaction following the 10th injection but an abscess was observed at the injection site after the 11th injection. Screening for an infectious aetiology was negative. Histological examination of a skin biopsy specimen demonstrated granulomatous inflammation with a necrotic centre. Intradermal reaction to triptorelin, an LH-RH analogue containing no excipient, was negative. Intradermal reaction to leuprorelin SR, which contains lactic acid polymer, was positive with the appearance of an erythematous papule after 20 minutes, as well as demonstration of granulomatous reaction upon histological examination of a biopsy specimen obtained 10 days later.This case suggests a foreign body reaction to leuprorelin SR, or more probably to the lactic acid polymer excipient, as seen with Newfill (L-polylactic acid) used to treat lipoatrophy.