La maladie de Whipple, infection bactérienne systémique chronique mais curable due à Tropheryma whipplei, affecte habituellement des hommes d’âge moyen et place le rhumatologue en première ligne. La forme historique associe typiquement un amaigrissement et une diarrhée précédés dans 3/4 des cas par une atteinte articulaire stéréotypée. Celle-ci évolue en moyenne depuis 6 ans lors du diagnostic, sous forme d’une oligoarthrite ou d’une polyarthrite chronique séronégative des grosses articulations mais qui a la particularité d’être intermittente, au moins au début. Une polyarthrite chronique destructrice septique peut ensuite survenir en l’absence de diagnostic. Une présentation sous forme d’une spondyloarthrite est aussi possible. Quelques cas de spondylodiscites ont été décrits ainsi que d’exceptionnelles ostéo-arthropathies hypertrophiantes. Chez la plupart des patients, dans la forme classique, la coloration par l’acide périodique de Schiff (PAS) des biopsies duodéno-jéjunales permet de révéler des inclusions macrophagiques qui correspondent à des structures bactériennes. Néanmoins, l’atteinte gastro-intestinale peut être absente cliniquement et même parfois en histologie voire par amplification génique. Même en l’absence d’atteinte digestive, le rhumatologue doit savoir évoquer la maladie de Whipple devant un tableau d’oligoarthrite intermittente s’il reste inexpliqué chez un homme d’âge moyen. La polymerase chain reaction (PCR) pour détecter l’acide nucléique de la bactérie à partir du liquide articulaire, de la salive et des selles, fait partie des examens de première intention à visée diagnostique, même si T. whipplei n’est pas fréquemment impliqué au cours des oligoarthrites ou polyarthrites séronégatives inexpliquées de l’homme. La PCR facilite le diagnostic précoce de la maladie avant l’apparition des complications systémiques sévères qui sont encore parfois fatales.Whipple disease is a chronic, curable, systemic infection caused by Tropheryma whipplei, which mostly affects middle-aged men and places the rheumatologist in the front line. The historical form typically associates weight loss and diarrhea preceded in 3/4 of the cases by a stereotypical articular involvement. This one evolves on average for 6 years before the diagnosis, with oligoarthritis or seronegative chronic polyarthritis affecting large joints but which is intermittent, at least at the beginning. A chronic septic destructive polyarthritis can then arise in the absence of diagnosis. A presentation with spondyloarthritis is also possible. Some cases of infectious spondylodiscitis have been described and even exceptional cases of hypertrophic osteo-arthropathy. In most of the patients with classic Whipple disease, duodeno-jejunal biopsies provide evidence of mucosa infiltration by foamy macrophages stained with periodic acid-Schiff, which correspond to bacterial structures. Nevertheless, the gastrointestinal involvement can be absent clinically and even sometimes in histology or even with PCR tests. In spite of the absence of digestive involvement, the rheumatologist should raise the diagnosis of Whipple disease in case of unexplained intermittent arthritis in a middle-aged man. Polymerase chain reaction (PCR) tests for T. whipplei from saliva, stools and synovial liquid are now included among the initial diagnostic tests, even if the bacterium is not frequently involved during oligoarthritis or unexplained seronegative polyarthritis in men. The PCR test facilitates the early diagnosis of the disease before the appearance of the severe systemic complications, which are still sometimes fatal.

Necrotizing fasciitis is a rare subcutaneous and superficial fascia infection. It often has a fulminant course and a mortality rate above 30%. The prognosis depends on early recognition and prompt medical and surgical intervention. This condition is caused mainly by polymicrobial combinations of anaerobic and aerobic bacteria. Themost common single causative bacteria are group A beta-haemolytic streptococci (Streptococcus pyogenes) and Staphylococcus aureus. Serratia marcescens is a Gram-negative bacillus belonging to the family Enterobacteriaceae. This bacterium was initially considered to cause infection only in immunocompromised patients. S. marcescens is now known to cause septicaemia, pneumonia, urinary tract infection, endocarditis and arthritis acquired both in the community and the hospital. Most cases are isolated but recently, nosocomial infections have increased and several outbreaks have been reported in critically ill neonates and adults on intensive care units. Furthermore, such infections may be difficult to treat because of multiple antibiotic resistant strains. We report here a case of necrotizing fasciitis of the leg exclusively due to S. marcescens in a patient on chemotherapy for a small cell lung cancer. A 49-year-old man was admitted to the hospital in June 2003 for cellulitis of the right leg of 2 days duration. His medical past history was relevant for a heavy alcohol intake and smoking, diabetes mellitus and myocardial infarction. In May 2003, he had been diagnosed with extensive small cell lung cancer and metastases to the liver, bone and left adrenal gland and had received the first course of chemotherapy combining carboplatin and etoposide 12 days before admission. On examination, the patient appeared acutely ill. His temperature was 38 C, blood pressure was 80 ⁄ 50 mmHg, and pulse was 90 ⁄min. The left calf was swollen, erythematous and painful. No portal of entry was found and no lymphadenopathy was palpable. Full blood count showed a haemoglobin level of 7.3 g ⁄ dL with 73 · 10 ⁄ L reticulocytes, a leucocyte cell count of 2.03 · 10 ⁄ L with 82% neutrophils and 3% lymphocytes. Serum creatinine, liver function tests and creatine phosphokinase level were within the normal range. C-reactive protein was 287 mg ⁄ L (normal, < 13mg ⁄ L). Serum protein electrophoresis showed an albumin level of 21.6 g ⁄ L (normal range, 39–46 g ⁄ L), alpha-2 globulin level of 10.7 g ⁄ L (normal range, 5–7 g ⁄ L) and gamma globulin level of 1.9 g ⁄ L (normal range, 6–10 g ⁄ L). Chest X-ray was unchanged from that taken 1 month before. Treatment with amoxicillin was begun. Subsequently one blood culture out of three grew S. marcescens within 36 h whereas urine culture remained negative. Antibiotic therapy combining piperacillin ⁄ tazobactam and amikacin was given to which the cultured bacteria were sensitive. However, 48 h later, the pain became severe, the erythema extended from the ankle to the popliteal area, with haemorrhagic bullae, necrosis, and bluish discoloration. There was no palpable crepitus. A diagnosis of necrotizing fasciitis was suspected and therefore an exploratory fasciectomy was performed with debridement of necrotic subcutaneous tissue and a small amount of necrotic muscle. Cultures from bullae and surgical specimens yielded S. marcescens within 24 h. No histological examination was performed. The patient died 3 weeks after admission from metastatic small cell lung carcinoma. Progressive but incomplete wound healing was observed of the debrided area. No other case of infection due to S. marcescens was observed in the hospital during the period of management of our patient. We report here a case of necrotizing fasciitis caused by S. marcescens as a single pathogen. The diagnosis was established clinically. Local signs included severe pain, haemorrhagic bullae, necrosis, bluish discoloration and findings of fascial necrosis and myonecrosis observed at the time of surgical exploration. These clinical signs observed in our patient as well as crepitus or toxic shock syndrome are clues to the diagnosis of necrotizing fasciitis leading to surgical exploration (that confirms the diagnosis) and extensive debridement. They distinguish this condition from other soft-tissue infections such as cellulitis, an acute spreading inflammation of the dermis and subcutaneous tissue, usually due to streptococci and Staphylococcus aureus, presenting with a tender, warm, erythematous and swollen area. The differential diagnosis may be difficult with haemorrhagic cellulitis, an extremely painful erythema of acute onset with ecchymotic areas and frequent superficial bullae resulting in haemorrhagic crusts in patients with underlying systemic diseases requiring both antibiotics and systemic corticosteroids. S. marcescens is rarely involved in soft tissue infections. Indeed, this agent has been found only in a few cases of dermal abscesses Viewpoints in dermatology • Correspondence

Rhodococcus equi is the most common infectious cause of mortality in foals between 1 and 6 months of age. Because of an increase in the number of antibiotic-resistant strains, the optimization of a prophylactic strategy is a key factor in the comprehensive management of R. equi pneumonia.The objectives of this study were to assess the safety and immunogenicity of R. equi-secreted proteins (ReSP) co-administered with either the nanoparticular adjuvant Montanide™ IMS 3012 VG, or a new polymeric adjuvant Montanide™ PET GEL A, and to further investigate the most immunogenic proteins for subsequent immunization/challenge experiments in the development of a vaccine against rhodoccocal pneumonia. The approach involved two phases. The first phase aimed to investigate the safety of vaccination in six adult horses. The second phase aimed to determine the safety and immunogenicity of vaccination in twelve 3-week-old foals.We set out to develop a method based on ultrasound measurements for safety assessment in adult horses in order to evaluate any in situ changes at the injection site, in the skin or the underlying muscle, with quantitative and qualitative data revealing that administration of ReSP combined with the Pet Gel A adjuvant led to an increase in local inflammation, associated with 4- to 7-fold higher levels of anti-R. equi IgGa, IgGb and IgGT, compared to administration of ReSP associated with IMS 3012 adjuvant, but without any impact on animal demeanor. Investigations were then performed in foals with serological and clinical follow-up until 6 months of age. Interestingly, we observed in foals a much lower incidence of adverse local tissue reactions at the injection site than in adult horses, with transient and moderate swelling for the group that received ReSP combined with Pet Gel A. Immunized foals with Pet Gel A adjuvant exhibited a similar response in both IgGa and IgGT levels, but a lower response in IgGb levels, compared to adult horses, with a subisotype profile that may however reflect a bias favorable to R. equi resistance. From the crude extract of secreted proteins, dot-blot screening enabled identification of cholesterol oxidase, mycolyl transferase 3, and PSP (probable secreted protein) as the most immunogenic candidates. Taken together, these results are encouraging in developing a vaccine for foals.

Letters| April 17 2003 Isotretinoin-Induced Bilateral Sacroiliitis Subject Area: Dermatology , Immunology and Allergy Claude Bachmeyer; Claude Bachmeyer aDépartement de Médecine Interne, Centre Hospitalier Laënnec, Creil, Search for other works by this author on: This Site PubMed Google Scholar Abdel Charoud; Abdel Charoud aDépartement de Médecine Interne, Centre Hospitalier Laënnec, Creil, Search for other works by this author on: This Site PubMed Google Scholar Yves Turc; Yves Turc aDépartement de Médecine Interne, Centre Hospitalier Laënnec, Creil, Search for other works by this author on: This Site PubMed Google Scholar Valérie Callot; Valérie Callot aDépartement de Médecine Interne, Centre Hospitalier Laënnec, Creil, Search for other works by this author on: This Site PubMed Google Scholar Laurent Blum; Laurent Blum bMédecine Générale, Hôpital René-Dubos, Pontoise, et Search for other works by this author on: This Site PubMed Google Scholar Sélim Aractingi Sélim Aractingi cUnité de Dermatologie, Hôpital Tenon, Paris, France Search for other works by this author on: This Site PubMed Google Scholar Dermatology (2003) 206 (3): 285–286. https://doi.org/10.1159/000069849 Article history Published Online: April 17 2003 Content Tools Views Icon Views Article contents Figures & tables Video Audio Supplementary Data Peer Review Share Icon Share Facebook Twitter LinkedIn Email Tools Icon Tools Get Permissions Cite Icon Cite Search Site Citation Claude Bachmeyer, Abdel Charoud, Yves Turc, Valérie Callot, Laurent Blum, Sélim Aractingi; Isotretinoin-Induced Bilateral Sacroiliitis. Dermatology 1 July 2003; 206 (3): 285–286. https://doi.org/10.1159/000069849 Download citation file: Ris (Zotero) Reference Manager EasyBib Bookends Mendeley Papers EndNote RefWorks BibTex toolbar search Search Dropdown Menu toolbar search search input Search input auto suggest filter your search All ContentAll JournalsDermatology Search Advanced Search Article PDF first page preview Close Modal 2003Copyright / Drug Dosage / DisclaimerCopyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements. You do not currently have access to this content.

BACKGROUND:The diagnostic and prognostic value of specific cutaneous lesions in acute leukemia is well-known. Paradoxically, these lesions may initially develop without peripheral blood or bone marrow involvement. We report the case of a patient with cutaneous lesions of acute monoblastic leukemia whereas peripheral blood was normal and massive infiltration of dermis was demonstrated.OBSERVATION:A 49 year-old man had papules and nodules of the back and upper arms evolving for several months. Histological examination with appropriate immunostaining led to the diagnosis of specific cutaneous lesions of acute monoblastic leukemia. Several hemograms with peripheral blood smears were normal, bone marrow smear demonstrated an important blastic infiltration on one site and a discrete infiltration on another. Cutaneous lesions disappeared with chemotherapy.DISCUSSION:Specific cutaneous lesions may be isolated during acute leukemia, and called aleukemic leukemia cutis. These are a rare form, the underlying mechanism of which relies on the accumulation of small quantities of myeloblasts in bone narrow and with high tropism for the dermis.

Bachmeyer, Claude; Alovor, Guy; Chatelain, Denis; Khuoy, Louis; Turc, Yves; Danon, Olivier; Laurette, Frederic; Cazier, Alain; N'Guyen, Van Author Information

PURPOSE: To report anterior uveitis as the initial sign of adult Kawasaki syndrome (mucocutaneous lymph node syndrome). METHODS: Case report. RESULTS: Kawasaki syndrome was diagnosed in an 18-year-old woman with reduction of vision caused by anterior uveitis, fever, erythemateous cutaneous rash, conjunctival injection, and cervical lymph adenopathy, after medical examination including serologic tests. Aspirin and intravenous immunoglobulin were given, resulting in improvement of the condition. CONCLUSION: Slit-lamp examination should be useful in the evaluation of patients with suspected Kawasaki syndrome, differentiating this condition from streptococcal and staphylococcal toxin-mediated diseases, viral infections, and drug reactions, not commonly associated with anterior uveitis.

The association of mast cell diseases and some hematologic malignancies, usually myeloproliferative disorders, myelodysplastic syndromes, and acute leukemia is well recognized. We report the case of a patient with telangiectasia macularis eruptiva perstans, a rare form of cutaneous mastocytosis, and multiple myeloma, an association that has been described only twice in the literature. Parallel improvement of both conditions was observed under chemotherapy regimens for multiple myeloma. Pathogenesis remains unclear, although the abnormalities in the c-kit pathway may play a role in the proliferation of cells from both lineages.