Leukocytoclastic vasculitis with severe renal involvement following Parvovirus B19 primary infection

BACKGROUND: Leukocytoclastic vasculitis following Parvovirus B19 primary infection has occasionally been reported in children but it occurs rarely in adults. We present an original case report with severe renal complications. PATIENTS AND METHODS: A 33-year-old man presented with fever and eruption of the abdomen and members. Papules and vesiculopustules were associated with oral and genital ulcerations. These lesions subsequently became purpuric and necrotic. Histological analysis confirmed the diagnosis of pustulous leukocytoclastic vasculitis with IgA deposits. Laboratory investigations showed elevated sedimentation rate, hepatic cytolysis and renal impairment (hematuria, leucocyturia and proteinuria 1.5 g/24 hours). Anti-parvovirus B19 IgM were positive. Three months after the eruption resolved, IgM were undetectable while anti-parvovirus B19 IgG appeared. Renal injury progressively worsened: elevation of proteinuria (5 g/24 hours) and diminution of creatinine clearance (51 ml/min). Renal biopsy showed glomerulonephritis with mesangial IgA deposits. Major proteinuria persisted one year after the disappearance of dermatological lesions in spite of ACE inhibitor treatment. DISCUSSION: The role of Parvovirus B19 has been suspected as an aetiological agent in many kinds of vasculitis, e.g. polyarteritis nodosa, Wegener's disease and leucocytoclastic vasculitis. In this case report, the detection of specific IgM and the absence of other factors associated with vasculitis are consistent with a causal role of Parvovirus B19. In previously published cases, the prognosis of parvovirus B19-associated vasculitis does not seem to differ from that of idiopathic vasculitis. To our knowledge, this is the first case exhibiting concomitant and persistent severe renal involvement.     

Validation of a clinical evaluation score for irritative dermatitis: SCOREPI

Background Most dermatological conditions can be evaluated using validate clinical scores, no such tool is available for irritant contact dermatitis (ICD). Objective To create and validate a grid‐based ICD severity score. Methods Three dermatologists developed the SCOre de REparation de l’EPIderme (SCOREPI) grid. Two studies were conducted to validate the SCOREPI. A cross‐sectional study assessed the intra‐ and inter‐observer error associated with using the SCOREPI. Each investigator received 15 min of training on proper use of the SCOREPI. A computer displayed a series of 20 photos of ICD, each of which were repeated three times in a randomized order. The prospective study assessed the correlation between SCOREPI with the severity of clinical symptoms as well as the sensitivity of the score to changes in ICD in response to topical treatment. Results The SCOREPI took an average of 35 ± 5 s to be completed and was characterized by an excellent intra‐observer and moderate inter‐observer reproducibility (intra‐class correlation coefficient = 0.93 and 0.74, respectively). Significant divergence was observed between the physicians’ assessment of estimated surface (P = 0.04), the presence of erythema (P < 0.0001) and the number of deep cracks (P = 0.0008). In the prospective analysis of patients, SCOREPI was correlated with tightness (r = 0.45; P < 0.0001), pain (r = 0.45; P < 0.0001), burning (r = 0.42; P < 0.0001), and pruritus (r = 0.28; P = 0.0055). SCOREPI decreased considerably during follow‐up from 10.45 ± 4.61 to 4.82 ± 4.15 (P < 0.0001). Conclusion The SCOREPI is easy to use, sensitive to change, and characterized by high intra‐ and moderate inter‐observer reliability.     

Rosacea under the microscope: characteristic histological findings

Rosacea is a common facial dermatosis that is seldom biopsied; thus, histological aspects have not been well described. Biopsies are generally performed in the presence of atypical symptoms (e.g. granulomas). Differential diagnosis with sarcoidosis, lupus miliaris or lupus erythematosus is another indication for biopsy. There are few published studies addressing the microscopic aspects of rosacea and describing the histological and immunohistochemical features of this disease. While some textbooks consider the microscopic signs of rosacea to be non‐diagnostic, experienced dermatopathologists are generally able to make the diagnosis via histology. This article discusses the specific combinations of histological features that are highly suggestive of rosacea.     

Eccrine porocarcinoma, tricholemmal carcinoma and multiple squamous cell carcinomas in a single patient.

A 75-year old woman without remarkable medical history presented with a large eccrine porocarcinoma of the trabelucar type located on her leg. This tumor was associated with two invasive squamous cell carcinomas of the legs, two Bowen's diseases of her thigh and arm and multiple actinic keratoses of the face. Despite major surgery, local recurrence of the porocarcinoma was observed 6 months later. During the 3-year follow-up after a second surgical intervention, this lesion did not reccur, but the patient developed a rapidly enlarging ulcerated tumor of the forehead which proved to be tricholemmal carcinoma. Although no carcinogenetic factor or familial history of multiple neoplasms could be evidenced, the occurrence of multiple tumors of various histogenesis over a 1 year period of time is unlikely to be fortuitous. Such an association of rare adnexal neoplasms has not yet been described.     

Expression of stromelysin 3 in basal cell carcinomas.

Stromelysin 3 is a member of the metalloproteinase family, which is expressed in various remodelling processes. The prognosis of breast cancers and squamous cell carcinomas is correlated to the level of expression of this protein. The purpose of the present work was to evaluate the expression of stromelysin 3 in the major types of basal cell carcinomas. We selected cases of primary tumours that were fully excised, without previous biopsy: 40 Pinkus tumors, 40 superficial, 40 nodular, 38 morpheiform basal cell carcinomas and 10 cases showing deep subcutaneous or muscular invasion. Immunohistochemistry was carried out using monoclonal anti-ST3 antibodies (MC Rio, IGBMC Strasbourg), and evaluated on a semi-quantitative scale from 0 to 3. Positively stained cells were restricted to the periphery of the epithelial cells, which, by contrast, never expressed stromelysin 3. The global rate of expression was 27% in Pinkus tumors, 65% in superficial, 72.5% in nodular, 87% in morpheiform and 100% in deeply invasive carcinomas. The rates of tumours showing the highest number of positively stained cells (class 2 or 3) were respectively 7.5%, 20%, 45%, 63% and 100%. This systematic study of stromelysin3 expression in basal cell carcinomas confirms that it is a marker of poor prognosis, because the rate of positive tumours was much higher in aggressive carcinomas. Moreover, the majority of tumours showing an intense expression (i.e. the highest number of positively stained cells in their stroma) were of the morpheiform and deeply invasive types, which are of poor prognosis. Altogether, the studies performed on cutaneous tumours are consistent with the theory of stromelysin 3 playing an active role in tumour progression.