D. Hamel

Fibroblastic rheumatism: fibromatosis rather than non-Langerhans cell histiocytosis

Background: Fibroblastic rheumatism is a unique fibro‐proliferative disease affecting the skin and joints. It is characterized by distinctive clinical and histological features related to benign spindle‐shaped cells proliferation. Pediatric reports are scarce in the literature.

First fixed drug eruption due to teicoplanin with a peri-oral distribution.

Editor Fixed drug eruption (FDE) is characterized by a recurrence of a localized eruption secondarily pigmented involving the same site(s) of skin or mucous membrane.1 This eruption is considered pathognomonic of a drug-induced dermatosis and occurs in the 24 or 48 h after medicine intake. Cotrimoxazole, oxybutazone and tetracyclin are the most common causes of FDE; few cases due to glycopeptide antibiotics were published.2 We report an unusual peri-buccal form of FDE due to teicoplanin. A 10-year-old girl was referred for a pigmented erythema around the mouth since the last 4 days. She was living in a medical institution and had a prior history of Hirschprung disease with terminal ileostomy. She developed a Staphylococcus aureus sepsis a week before, which was initially treated by a 48-h intravenous bi-antibiotic therapy, vancomycin and rifamycin then associated to amikacin because of a persistent fever. After complete identification of staphylococcus resistance, the treatment was switched for perfusions associating teicoplanin and amikacin. Forty-eight hours later, after three injections of teicoplanin (one every 12 h), the patient developed a pruriginous lip oedema and a pigmented erythema around the mouth. Teicoplanin was stopped and the lip oedema rapidly solved. On examination, there was a wellcircumscribed 10-cm pigmented eruption around the mouth with a peripheral slight desquamation, central erosion, a dry cheilitis (Fig. 1) and a 2-cm well-delimited preauricular pigmented plaque. There was no other lesion on the body nor mucous membrane involvement. Topical betamethasone dipropionate was applied, and few days later, the lesions disappeared with a residual pigmentation. On further inquiry, teicoplanin had been administered in July 2006 and a similar episode was noted. After two injections, the patient had a pruriginous lip oedema, the antibiotic administration was slowed down and dexchlorpheniramine was added. After a 3rd injection, the manifestation relapsed and a pigmented erythema occurred around the lips. Teicoplanin was discontinued and the eruption disappeared leaving a discrete hyperpigmentation. These two regressive episodes of a pigmented erythema around the mouth after same drug administration led us to the diagnosis of FDE due to teicoplanin. Teicoplanin is an antibiotic of the glycopeptide class. It is frequently used because of the increasing number of infections due to Methicillin-resistant Staphylococcus aureus. Dermatological adverse events are less common with teicoplanin than vancomycin.2 ‘Red man syndrome’, maculopapular exanthema, toxic epidermal necrolysis, IgA linear dermatosis and FDE have been described with vancomycin.3 Cases of toxic epidermal necrolysis and drug hypersensitivity have been reported in relation to teicoplanin,4 but we found in a PubMed survey no published case of FDE attributed to teicoplanin. The pharmacovigilance department of teicoplanin manufacturer Aventis and of Hôpital Necker-Enfants-malades did not mention being aware of the FDE report. FDE is characterized by the relapse of the eruption in the same location after the administration of the causative drug. Finally, we report the first case of FDE to teicoplanin; in our observation, teicoplanin was twice associated to the same eruption. Because of the natural history of the drug eruption and the topography of the lesion, we did not propose a provocation test.

Lichen plan vulvaire chez l’enfant

Resume Introduction Le lichen plan de l’enfant est plus rare que celui de l’adulte ; sa localisation est essentiellement cutanee. Observation Une enfant de 9 ans etait adressee pour une lesion situee a la face interne de la grande levre gauche, bleu violine, asymptomatique decouverte depuis 4 mois et stable. L’examen anatomopathologique revelait un lichen plan vulvaire. L’evolution etait rapidement favorable sous dermocorticoides de classe tres forte. Discussion Nous rapportons le premier cas de lichen plan vulvaire isole chez une petite fille. Au cours du lichen plan de l’enfant, l’atteinte muqueuse est rare, et la localisation genitale exceptionnelle. Le principal diagnostic differentiel est le lichen sclereux vulvaire. Les risques de synechies vaginales et de transformation maligne, connus chez l’adulte, justifient une surveillance au long cours.