A.-M. Tasei

Hypodermite granulomateuse révélatrice d’une mucormycose chez une malade immunodéprimée

Resume Introduction Les mucormycoses sont des infections fongiques opportunistes exceptionnelles malgre le caractere ubiquitaire de leurs agents pathogenes. Elles sont parfois revelees par une atteinte cutanee primitive et leur pronostic devient tres mauvais en cas de dissemination viscerale. Notre observation illustre la necessite d’un diagnostic et d’un traitement precoces de ces infections. Observation Une femme de 45 ans immunodeprimee, developpait des lesions d’hypodermite necrotique des membres inferieurs. Une biopsie cutanee permettait le diagnostic de mucormycose. Malgre un traitement par amphotericine liposomiale, l’evolution etait rapidement defavorable avec dissemination viscerale de l’infection fongique (localisations pulmonaire et cerebrale) et deces de la malade. Discussion Ce cas souligne la gravite potentielle des mucormycoses, actuellement emergentes en milieu onco-hematologique. Ces infections sont parfois revelees par des lesions cutanees ulcerees et/ou necrotiques inaugurales. Leur diagnostic doit etre evoque tres precocement pour initier un traitement medico-chirurgical salvateur.INTRODUCTION Mucormycosis is an exceptional opportunist fungal infection, despite the ubiquitous nature of its pathogenic agents. It is sometimes revealed by primary cutaneous involvement and its prognosis is bad in the case of visceral dissemination. Our observation illustrates the need for early diagnosis and treatment of this infection. OBSERVATION An immunodepressed, 45 year-old woman, had developed necrotic hypodermitis lesions on the lower limbs. The skin biopsy led to the diagnosis of mucormycosis. Despite treatment with liposomal amphotericin, the fungal infection worsened, spread to the organs (lungs and brain) and the patient died. DISCUSSION This case report underlines the potential severity of mucormycosis, which is presently emerging in the onco-hematological field. The infection is sometimes revealed by inaugural ulcerated and/or necrotic cutaneous lesions. Its diagnosis must be evoked early so that salvage medical-surgical treatment can be initiated.

Granulomes induits par des injections de leuproréline acétate (Enantone

BACKGROUND Gonadorelin analogues (LHRH) are used for the endocrine treatment of prostatic cancer, central early puberty and various gynaecological conditions. Cutaneous adverse events seldom occur. We report a case of injection-site granulomas induced by leuprorelin acetate (Enantone®). CASE REPORT A 76-year-old man presented with several subcutaneous nodules on his left arm. The nodules were hard but painless. He had received subcutaneous injections of Enantone® for prostatic cancer. Histological examination of a skin biopsy specimen demonstrated granulomatous inflammation with a necrotic centre; screening for an infectious aetiology was negative. Serial sections showed giant cells containing translucent round microspheres in the subcutaneous tissue. Limitation to the leuprorelin acetate injection sites in the arm and detection at histological analysis of microspheres probably bound to an injected product militated in favour of granulomas caused by injections of Enantone®. DISCUSSION Injection-site granulomas caused by Enantone® are rare. Their formation may depend on the mode of administration: the more superficial the injection, the higher the risk of developing granulomas. The formation of these lesions is probably a foreign body reaction to the excipient.