Background and Objective: The objective of this study was to evaluate the relationship between Jessner’ s lymphocytic infiltration of the skin (JLI) and lupus erythematosus (LE), which has been the subject of debate ...Background and Objective: The objective of this study was to evaluate the relationship between Jessner’ s lymphocytic infiltration of the skin (JLI) and lupus erythematosus (LE), which has been the subject of debate since its initial description in 1953. Material and Methods: This is a retrospective study including all patients with a histopathologically ascertained diagnosis of JLI performed at the Laboratoire d’ Histopathologie Cutan′ ee of the Strasbourg University Hospital between 1993 and 2003. Information about patient characteristics and follow-up data were retrieved between 2004 and 2005. Special attention was paid to features indicative of LE. Results: 210 consecutive patients (102women and 108 men) with a mean age 42 years were diagnosed with JLI in the reference period. 175 patients (83% ) had multiple lesions and 32 patients (15% ) had only a single lesion at the time of diagnosis (data not available in 3 patients). The head, neck and upper part of the thorax were involved in 171 patients (81% ). An annular or arciform configuration and/or arrangement were present in 111 patients (53% ). Lesions consisted of red (100% ) papules or plaques (98% ). Mean follow-up was 4 years. Sixteen patients (7.6% ) had proven LE. Only 2 patients (1% ) developed >4 ACR criteria of systemic LE. Furthermore, 1 patient had antiphospholipid antibody syndrome and 2 patients had rheumatoid arthritis. Conclusions: This high frequency of patients with typical features of LE strongly argues that JLI could be a dermal variant of LE and not an autonomous entity. It might be the cutaneous marker of a subset of LE patients with excellent prognosis.展开更多
Introduction. Cutaneous actinomycosis of the buttocks is a rare granulomatous bacterial infection that usually starts in the perianal area. We present an exceptional case in the form of a pseudo-tumor. Case report. A ...Introduction. Cutaneous actinomycosis of the buttocks is a rare granulomatous bacterial infection that usually starts in the perianal area. We present an exceptional case in the form of a pseudo-tumor. Case report. A 69 year-old woman, in general good health, developed an indurate mass on the supra-external quadrant of the right buttock. The tumor was centered by an ulcerated nodule with a diameter of around 10 centimeters. Imaging showed invasion of the soft tissue of the skin in the internal psoas muscle, the adipose tonality of which was compatible with a liposarcoma.The skin biopsy revealed characteristic bacterial grain in the center of a cholesterol granuloma. Subsequent culture in aerobic milieu identified Actinomyces gerencseriae. Cure was obtained following complete exeresis of the fibrous tissue and 8 months of antibiotic amoxicillin-clavulanic acid therapy. Discussion. Otherthan the most unusual clinical aspect, the originality of this case of actinomycosis of the buttocks is based on its potential appendix origin, 4 years after acute appendicitis, with slow posterior fistulation. Other cases of actinomycosis of appendix origin have been reported and its delayed onset following the intervention has been documented. The pseudo-sarcomatous aspect was responsible for diagnostic wandering. The histological image and, subsequently, the results of the bacteriological culture confirmed the diagnosis.展开更多
Introduction. Superficial granulomatous pyoderma is a rare variant of pyoderma gangrenosum, which is often diagnosed at a late stage because of misleading cli nical-histopathological features. We report a new case of ...Introduction. Superficial granulomatous pyoderma is a rare variant of pyoderma gangrenosum, which is often diagnosed at a late stage because of misleading cli nical-histopathological features. We report a new case of this rare disease. Ca se report. A 67 year-old man presented with inflammatory lesions that had becom e ulcerated over the past 4 months despite prolonged antibiotic therapy. The his topathological aspect was initially suggestive of palisading granuloma annulare and subsequently a necrotizing granuloma compatible with a mycobacteriosis. The various supplementary examinations eliminated the possibility of an infectious o r systemic disease. The lesions became painful and ulcerated. A second biopsy sh owed a neutrophilic dermatosis with dermal necrosis and a granuloma leading to t he diagnosis of superficial granulomatous pyoderma. The lesions healed after 3 m onths of systemic corticosteroids at the dose of 1 mg/kg/day. Discussion. The cl inical features of superficial granulomatous pyoderma are similar to those of cl assical pyoderma gangrenosum. However, its histological profile is more superfic ial and is associated with dermal granulomas. The latter are unusual in neutroph ilic dermatosis and would suggest an infectious disease. This explains the frequ ent diagnostic errors, with inappropriate anti-infectious treatments and notabl y unnecessary surgical exeresis.展开更多
文摘Background and Objective: The objective of this study was to evaluate the relationship between Jessner’ s lymphocytic infiltration of the skin (JLI) and lupus erythematosus (LE), which has been the subject of debate since its initial description in 1953. Material and Methods: This is a retrospective study including all patients with a histopathologically ascertained diagnosis of JLI performed at the Laboratoire d’ Histopathologie Cutan′ ee of the Strasbourg University Hospital between 1993 and 2003. Information about patient characteristics and follow-up data were retrieved between 2004 and 2005. Special attention was paid to features indicative of LE. Results: 210 consecutive patients (102women and 108 men) with a mean age 42 years were diagnosed with JLI in the reference period. 175 patients (83% ) had multiple lesions and 32 patients (15% ) had only a single lesion at the time of diagnosis (data not available in 3 patients). The head, neck and upper part of the thorax were involved in 171 patients (81% ). An annular or arciform configuration and/or arrangement were present in 111 patients (53% ). Lesions consisted of red (100% ) papules or plaques (98% ). Mean follow-up was 4 years. Sixteen patients (7.6% ) had proven LE. Only 2 patients (1% ) developed >4 ACR criteria of systemic LE. Furthermore, 1 patient had antiphospholipid antibody syndrome and 2 patients had rheumatoid arthritis. Conclusions: This high frequency of patients with typical features of LE strongly argues that JLI could be a dermal variant of LE and not an autonomous entity. It might be the cutaneous marker of a subset of LE patients with excellent prognosis.
文摘Introduction. Cutaneous actinomycosis of the buttocks is a rare granulomatous bacterial infection that usually starts in the perianal area. We present an exceptional case in the form of a pseudo-tumor. Case report. A 69 year-old woman, in general good health, developed an indurate mass on the supra-external quadrant of the right buttock. The tumor was centered by an ulcerated nodule with a diameter of around 10 centimeters. Imaging showed invasion of the soft tissue of the skin in the internal psoas muscle, the adipose tonality of which was compatible with a liposarcoma.The skin biopsy revealed characteristic bacterial grain in the center of a cholesterol granuloma. Subsequent culture in aerobic milieu identified Actinomyces gerencseriae. Cure was obtained following complete exeresis of the fibrous tissue and 8 months of antibiotic amoxicillin-clavulanic acid therapy. Discussion. Otherthan the most unusual clinical aspect, the originality of this case of actinomycosis of the buttocks is based on its potential appendix origin, 4 years after acute appendicitis, with slow posterior fistulation. Other cases of actinomycosis of appendix origin have been reported and its delayed onset following the intervention has been documented. The pseudo-sarcomatous aspect was responsible for diagnostic wandering. The histological image and, subsequently, the results of the bacteriological culture confirmed the diagnosis.
文摘Introduction. Superficial granulomatous pyoderma is a rare variant of pyoderma gangrenosum, which is often diagnosed at a late stage because of misleading cli nical-histopathological features. We report a new case of this rare disease. Ca se report. A 67 year-old man presented with inflammatory lesions that had becom e ulcerated over the past 4 months despite prolonged antibiotic therapy. The his topathological aspect was initially suggestive of palisading granuloma annulare and subsequently a necrotizing granuloma compatible with a mycobacteriosis. The various supplementary examinations eliminated the possibility of an infectious o r systemic disease. The lesions became painful and ulcerated. A second biopsy sh owed a neutrophilic dermatosis with dermal necrosis and a granuloma leading to t he diagnosis of superficial granulomatous pyoderma. The lesions healed after 3 m onths of systemic corticosteroids at the dose of 1 mg/kg/day. Discussion. The cl inical features of superficial granulomatous pyoderma are similar to those of cl assical pyoderma gangrenosum. However, its histological profile is more superfic ial and is associated with dermal granulomas. The latter are unusual in neutroph ilic dermatosis and would suggest an infectious disease. This explains the frequ ent diagnostic errors, with inappropriate anti-infectious treatments and notabl y unnecessary surgical exeresis.
