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Background: Nicolau's livedoid dermatitis is associated with drug-induced embolism in the cutaneous arterial bed, generally as a result of accidental intra-arterial injection. Herein, we report a case that is somewhat surprising because of its late onset following mesotherapy injections., Case Report: A 53-year-old man, with a history solely of tendinopathy for which he underwent mesotherapy sessions, consulted for livedoid lesions of the front of the knee with central necrosis. History-taking revealed a final course of mesotherapy three weeks earlier for patellar tendinitis below the left kneecap; intradermal injection of procaine and piroxicam had been unusually and intensely painful. The remainder of the clinical examination revealed additional livedoid lesions on the outside of the left ankle as well as purpuric lesions on the pads of the toes on the left foot. Laboratory tests revealed nothing of note. Skin biopsies of the livedoid circumference of the lesion showed arteriolar emboli of an amorphous material within the dermis obliterating the arteriolar lumen. The clinical appearance of skin lesions after mesotherapy led us to a diagnosis of Nicolau livedoid dermatitis., Discussion: Nicolau dermatitis is a rare skin complication described as occurring mainly as a result of intramuscular injections. The reported case is special because it comprises Nicolau dermatitis arising out of a session of mesotherapy employing an intradermal injection. However, there are only very few cases in which subcutaneous injections have induced Nicolau dermatitis. The pathophysiology is not well known, but several mechanisms are involved: arterial ischaemia by vasospasm or thrombosis. In this case, the semiotic appearance of the lesions and histological analysis militate in favour of accidental injection of a skin product into an arteriole, resulting in obliteration of the latter. Mesotherapy can induce Nicolau dermatitis., (Copyright © 2013. Published by Elsevier Masson SAS.)

Introduction: We report a case of a transient corneal edema related to systemic NSAID treatment., Observation: A 48-year-old woman treated with a systemic NSAID [piroxicam B-cyclodextrin (Brexin) and naproxen (Apranax)] presented with a corneal edema and a transient decrease in visual acuity for a period of 24 h. No ocular etiology was found to explain this corneal edema. Another treatment with Apranax was follow by another corneal edema., Conclusion: Corneal edema could be related to systemic NSAID treatment.

Some treatment as Piroxicam and sulfoconjugated oestrin usually used in current practices, have a rare ear toxicity which may occur hearing loss. The authors report two cases of a toxic hearing loss observed after using these two medicaments.

Background: Lymphocytic colitis is a chronic diarrhea syndrome with no endoscopically detectable anomaly and histological colonic lesions., Case Report: A 52-year-old woman was hospitalized for chronic diarrhea. She experienced 10 to 30 liquid bowel movements per day. Symptoms had begun 8 days after taking piroxicam fl-cyclodextrin. Intraepithelial cell counts on rectum and colon endoscopic biopsies showed more than 20% lymphocytes, giving the diagnosis of lymphocytic colitis. The patient was given 5ASA 3 g/24 h. Symptoms regressed in less than one week., Discussion: Lymphocytic colitis is uncommon. The cause remains unknown but a secondary autoimmune mechanism triggered by drugs has been suggested. This case would implicate nonsteroidal antiinflammatory drugs. Certain authors have demonstrated that they can be involved in the development of collagen colitis.

We present the results of a study, spread over a 12-year period, concerning the frequency of skin sensitization to mercury and some of its compounds in a Spanish community. Among 2,592 subjects suspected of allergic contact dermatitis, 3.5 p. 100 had a positive test to metallic mercury 0.5 p. 100 in petroleum jelly. The pertinence of the test was regarded as "present" or "fast" in 63.9 p. 100 of the cases, and the dermatitis was found to be related to antiseptic Mercurochrome (merbromin) solutions, cosmetics containing ammoniated mercury and inhalation of mercury after breaking of thermometers. We consider that in children metallic mercury should be tested at a concentration not exceeding 0.1 p. 100. Among 2,154 subjects suspected of allergic contact dermatitis, 109 (5 p. 100) had a positive test to thiomersal 0.1 p. 100 in petroleum jelly. The pertinence of the test was regarded as "present" or "past" in 53.8 p. 100 of the cases, and the dermatitis was attributed to antiseptic solutions, eye drops, cosmetics and shoes. There was no cross-reaction between thiomersal and mercury, except in those cases where mercury chloride was the allergic determinant responsible for sensitization to thiomersal (39.4 p. 100 of the cases). Fifteen patients consulted for photoallergy to piroxicam, and all had a positive test to thiosalicylic acid which is the compound most frequently responsible for sensitization to thiomersal (51.6 p. 100 of our cases) and for cross-reaction between thiomersal and piroxicam.

A case of peripheral neuropathy following treatment with piroxicam is reported. The patient developed muscle pain and asymmetrical sensory distal neuropathy of the lower limbs a few months after the onset of the treatment. Piroxicam was withdrawn and full recovery was achieved within one year. The simultaneous appearance in the same patient of erythroderma with microvasculitis on nerve and skin biopsies suggests a common type III hypersensitivity mechanism in the pathogenesis of these two side-effects of piroxicam.

The influence of tenoxicam on renal function was studied prospectively in two different populations. Group I (n = 10) was classified as "high renal risk" patients and received 20 mg of tenoxicam per day for five days. Glomerular filtration rate measured with Cr51 EDTA decreased significantly by 13 +/- 3.6% (p less than 0.01). Group II (n = 56) were outpatients from the rheumatology clinic and received 20 mg tenoxicam per day for one to five years. Plasma creatinine did not change significantly, except in one patient who had some degree of renal impairment before therapy. Tenoxicam carries no greater renal risks than other non-steroidal antiinflammatory drugs when administered to a non-"high renal risk" population. On the other hand, simple renal function monitoring should be carried out in high risk patients.