RESUMO
INTRODUCTION: Imatinib (Glivec) is a new therapeutic molecule used for the treatment of chronic myeloid leukemia. Cutaneous side effects with this treatment are common but lichenoid drug eruption is exceptional. We report the first case with profuse cutaneous lichen. CASE REPORT: A 52 year-old woman presented with a 5-year history of chronic myeloid leukemia. The different chemotherapies had failed (persisting polyadenopathies and splenomegalia). She was treated with imatinib (400 mg/day). Two months after the beginning of this treatment a disseminated cutaneous eruption appeared on the trunk, legs, arms and face without mucosal involvement and composed of dark purple, prurigenous, papules suggestive of lichen planus. The cutaneous biopsy confirmed the diagnosis of lichen planus. Suspension of the drug led to the complete regression of the eruption, without any other local treatment, within 2 months. Reintroduction of the drug led to the recurrence of the lesions. DISCUSSION: Cutaneous reactions to imatinib are common and occur in 11 to 67 p. 100 of patients depending on the series. More severe cutaneous reactions have been described: exfoliating dermatites, generalized pustulosis, epidermal necrolysis. The aspect of profuse lichenoid eruption of the skin and the correlation with cutaneous lesions clinically and histologically evocative of lichen planus has not been described other than an isolated buccal involvement in a 72 year-old woman. In our patient, study of the imputability criteria is in favor of imatinib's responsibility.
Assuntos
Antineoplásicos/efeitos adversos , Toxidermias/etiologia , Erupções Liquenoides/induzido quimicamente , Piperazinas/efeitos adversos , Pirimidinas/efeitos adversos , Benzamidas , Feminino , Humanos , Mesilato de Imatinib , Pessoa de Meia-IdadeRESUMO
A registry of hematological malignancies is held in the unit of cytology of the University Hospital of Martinique. Human T cell lymphotropic virus type-1 (HTLV1) is endemic in this island. We determined the incidence and epidemiological features of hematological malignancies from the 715 new cases diagnosed between 1990 and 1998 among the adult population. Incidence rates per year were steady during this period. The most frequent hematological malignancies were multiple myeloma (MM) (34%), followed by non-Hodgkin's lymphoma (NHL) (23%). Among the cases of NHL with an immunohistological study, 57% had a T cell phenotype. Among these 61% were adult T cell leukemia/lymphoma. Epidemiological data on hematological malignancies in the West Indies has not been previously reported. There are two striking differences with other population-based registries: a high incidence of MM (5/100000) and a high proportion of T cell NHL among NHL (57%). The high proportion of T cell NHL is probably due to the high incidence of ATL. A low incidence of B cell NHL might also contribute to this effect. The increased incidence of MM in West Indies had not been previously reported. A similar high incidence of MM has been reported among Afro-Americans in the USA.
Assuntos
Leucemia-Linfoma de Células T do Adulto/epidemiologia , Linfoma não Hodgkin/epidemiologia , Mieloma Múltiplo/epidemiologia , Adulto , Idoso , População Negra , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Sistema de Registros , Índias Ocidentais/epidemiologiaRESUMO
Diffuse or multifocal tuberculosis (TB) accounts for 9% to 10% of cases of extrapulmonary TB and carries a poor prognosis with a mortality rate of 16% to 25%. Forty-nine cases of multifocal TB defined as involvement of two extrapulmonary sites with or without pulmonary TB were reviewed. Mean patient age (+/- SD) was 50 +/- 18 years. Twenty-three per cent of patients were immigrants. A history of TB and contact with a TB patient were found in 23% and 18% of cases, respectively. Of the 52% of immunocompromised patients, 38% were HIV-positive. The skin tuberculin test was positive in 67% of cases. Mean time from symptom onset to admission was 80 +/- 77 days (median, 58 days). The 49 patients had a total of 128 TB foci. Six patients had positive blood cultures. The tubercle bacillus was recovered from the extrapulmonary sites in 88% of cases. Mean treatment duration was nine months. Recovery from the TB was achieved in 64% of cases. The overall mortality rate was 47%, and 33% of patients died as the direct result of TB. Most deaths occurred in immunocompromised patients. A high index of suspicion for multifocal TB should be maintained in immunocompromised patients, even those who test negative for the HIV.
Assuntos
Tuberculose/epidemiologia , Infecções Oportunistas Relacionadas com a AIDS/epidemiologia , Adulto , África/etnologia , Idoso , Idoso de 80 Anos ou mais , Suscetibilidade a Doenças , Emigração e Imigração , Feminino , França/epidemiologia , Guadalupe/etnologia , Haiti/etnologia , Humanos , Hospedeiro Imunocomprometido , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Tempo , Teste Tuberculínico , Tuberculose/diagnóstico , Tuberculose/patologiaRESUMO
A study was conducted between January 1984 and March 1985 to determine the prevalence of diabetes in the adult population of Guadeloupe (18 years of age and over). A two-step sampling frame, using a sampling fraction of 0.46%, where the primary units were composed of districts and where sub-units were households, was used. The household refusal rate was 22%. Subjects were classified as 'diabetic' when they were either already known or when their fasting plasma glucose was above 8.0 mmol/l. The total age and sex standardized prevalence of diabetes among the adult population of Guadeloupe can be estimated at 6.6%. The high prevalence rate appears to be related to obesity (strongly in women), a genetic susceptibility (22.5% of age standardized prevalence among subjects of Asian Indian origin for both sexes), and, possibly, in men of African origin only, to a maternal history of diabetes.
Assuntos
Diabetes Mellitus/epidemiologia , Hiperglicemia/epidemiologia , Adulto , Idoso , Glicemia/metabolismo , Diabetes Mellitus/etiologia , Diabetes Mellitus/genética , Feminino , Humanos , Hiperglicemia/metabolismo , Masculino , Pessoa de Meia-Idade , Obesidade , Prevalência , Fatores de Risco , Índias Ocidentais/epidemiologiaRESUMO
Intestinal angiostrongyliasis caused by Angiostrongylus costaricensis is a rare nematodiasis which is present mainly in Costa-Rica, and in some other countries in the northern part of South America, Central America, and in the southern part of Mexico. This is a report of the first case from Martinique involving a sixteen month old child, and proved by an intestinal pathologic study. The epidemiology of the disease, its clinical, parasitological, histopathologic and therapeutic aspects are emphasized.