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2. Effectiveness and safety of nivolumab in patients with advanced melanoma: A multicenter, observational study

Author

Stéphane Dalle, Patrick Combemale, Yannick Le Corre, Caroline Dutriaux, E. Varey, Nathalie Beneton, Thomas Jouary, Caroline Robert, Henri Montaudié, Jean Philippe Arnault, Sandrine Monestier, Marie Thérèse Leccia, Sandrine Mansard, Laurent Mortier, Amir Khammari, Anne-Bénédicte Duval Modeste, François Skowron, Nicolas Meyer, Brigitte Dréno, Nabahet Ameur, Bernard Guillot, Philippe Saiag, E. Hainaut, Sophie Dalac-Rat, Service de dermatologie, vénéreologie et cancérologie cutanée [Hôpital de la Timone - APHM], Hôpital de la Timone [CHU - APHM] (TIMONE)-Assistance Publique - Hôpitaux de Marseille (APHM)-Aix Marseille Université (AMU), Centre de Recherche en Cancérologie de Lyon (UNICANCER/CRCL), Centre Léon Bérard [Lyon]-Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Thérapies Laser Assistées par l'Image pour l'Oncologie - U 1189 (ONCO-THAI), Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Lille, CHU Bordeaux [Bordeaux], Service de Dermatologie (CHU de Dijon), Centre Hospitalier Universitaire de Dijon - Hôpital François Mitterrand (CHU Dijon), Institut Universitaire du Cancer de Toulouse - Oncopole (IUCT Oncopole - UMR 1037), Université Toulouse III - Paul Sabatier (UT3), Université Fédérale Toulouse Midi-Pyrénées-Université Fédérale Toulouse Midi-Pyrénées-CHU Toulouse [Toulouse]-Institut National de la Santé et de la Recherche Médicale (INSERM), Centre Hospitalier Universitaire [Grenoble] (CHU), CHU Clermont-Ferrand, Hôpital Archet 2 [Nice] (CHU), Biomarqueurs et essais cliniques en Cancérologie et Onco-Hématologie (BECCOH), Université de Versailles Saint-Quentin-en-Yvelines (UVSQ)-Université Paris-Saclay, Hôpital Ambroise Paré [AP-HP], Centre Léon Bérard [Lyon], CHU Montpellier, Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier), Hôpital Charles Nicolle [Rouen], Centre Hospitalier Le Mans (CH Le Mans), Centre hospitalier universitaire de Poitiers (CHU Poitiers), Département de médecine oncologique [Gustave Roussy], Institut Gustave Roussy (IGR), Service de dermatologie [CHU d'Amiens-Picardie], CHU Amiens-Picardie, Centre Hospitalier Universitaire d'Angers (CHU Angers), PRES Université Nantes Angers Le Mans (UNAM), Centre hospitalier de Pau, Centre d’Investigation Clinique de Nantes (CIC Nantes), Université de Nantes (UN)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre hospitalier universitaire de Nantes (CHU Nantes), Amgen Bristol-Myers Squibb, BMS Pfizer Novartis Roche AbbVie Les Laboratories Pierre Fabre LEO Pharma Research Foundation, Sandrine Monestier has received consultant fees from BMS and Roche, support for travel/congress from BMS, Roche, GSK and MSD, and has participated as an investigator on clinical trials for BMS, Roche‐ Genentech, GSK, Amgen, Novartis, MSD, Merck‐Serono and Astra Zeneca. Stéphane Dalle has received congress invitation and fees coverage from BMS, Pierre Fabre and MSD, translational study grant to institution from BMS and MSD. Laurent Mortier received support to travel to medical congresses from BMS, MSD, Roche and Novartis. Caroline Dutriaux has been a member of advisory boards and received consultancy fees from BMS, MSD, Pierre Fabre and Novartis. Sophie Dalac‐Rat has received honoraria, provided consultancy and been on advisory committees for BMS, MSD, Novartis and Sun pharma. Nicolas Meyer has received honoraria from Sun Pharma, Roche, Novartis and Pierre Fabre, research funding from BMS, MSD, provided consultancy to BMS, MSD, Roche, Novartis and Pierre Fabre, been on advisory committees for Amgen, Incyte, BMS, MSD, Roche, Novartis and Pierre Fabre. Sandrine Mansard has worked on advisory boards for BMS and Novartis, has received congress and travel fees from BMS and Pierre Fabre. Henri Montaudié has worked on advisory boards for BMS, MSD, Pierre Fabre and Novartis, provided consultancy to MSD and Pierre Fabre, received honoraria from BMS, MSD, Pierre Fabre and Novartis, received research funding from BMS and Leo Pharma. Philippe Saiag has received personal fees from Amgen, Bristol‐Myers Squibb, MSD, Merck‐Serono, Pfizer, Roche‐Genentech, Pierre Fabre and Novartis, received nonfinancial support from Bristol‐Myers Squibb, MSD, Roche‐Genentech and Novartis, received a funding grant from Roche‐Genentech. Patrick Combemale has worked on advisory committees for Roche, Pierre Fabre and AstraZenecca. Ewa Hainaut has been a speaker for BMS, Novartis and Sanofi, worked on advisory boards for Novartis and Sanofi, received research funding from Abbvie. Caroline Robert has received consultancy fees from BMS, MSD, Roche, Novartis, Sanofi, Pierre Fabre and Amgen. Yannick Le Corre has provided consultancy to BMS, MSD and Novartis, worked on advisory boards for BMS, MSD, Novartis and Pierre Fabre, received congress invitation from BMS, MSD and Novartis, has received honoraria from BMS. Nabahet Ameur is employee of Bristol‐Myers‐Squibb. Brigitte Dréno has received research funding from Amgen, BMS, Novartis and Roche, provided consultancy to BMS and Roche, worked on advisory boards for BMS, Roche and Pierre Fabre. Jean Philippe Arnault has been a speaker for BMS. Marie Thérèse Leccia, Bernard Guillot, François Skowron, Anne‐Bénédicte Duval Modeste, Nathalie Bénéton, Thomas Jouary, Emilie Varey, and Amir Khammari have no conflicts of interest to declare., Aix Marseille Université (AMU)-Assistance Publique - Hôpitaux de Marseille (APHM)- Hôpital de la Timone [CHU - APHM] (TIMONE), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Lille-Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille), Université Fédérale Toulouse Midi-Pyrénées-Université Fédérale Toulouse Midi-Pyrénées-Centre Hospitalier Universitaire de Toulouse (CHU Toulouse)-Institut National de la Santé et de la Recherche Médicale (INSERM), CHU Rouen, Normandie Université (NU)-Normandie Université (NU), HAL UVSQ, Équipe, and Université de Toulouse (UT)-Université de Toulouse (UT)-Centre Hospitalier Universitaire de Toulouse (CHU Toulouse)-Institut National de la Santé et de la Recherche Médicale (INSERM)

Subjects
Male, advanced melanoma, safety, Cancer Research, medicine.medical_specialty, real-world, Databases, Factual, effectiveness, [SDV.CAN]Life Sciences [q-bio]/Cancer, 03 medical and health sciences, 0302 clinical medicine, Antineoplastic Agents, Immunological, [SDV.CAN] Life Sciences [q-bio]/Cancer, Internal medicine, medicine, Humans, In patient, Adverse effect, Melanoma, Advanced melanoma, Aged, Retrospective Studies, Aged, 80 and over, nivolumab, business.industry, Incidence (epidemiology), Retrospective cohort study, Middle Aged, Survival Analysis, 3. Good health, Clinical trial, Treatment Outcome, Oncology, 030220 oncology & carcinogenesis, Observational study, France, Nivolumab, business
Abstract

International audience; This retrospective observational study aimed to determine the effectiveness, safety and patterns of the use of nivolumab in patients with advanced melanoma in real-world clinical practice in France using data from a Temporary Authorization for Use Program (ATU). Data were collected from patients with unresectable or metastatic melanoma enrolled in a French national database (Réseau pour la Recherche et l'Investigation Clinique sur le Mélanome: Ric-Mel) and treated with nivolumab during the ATU program (12 September 2014 to 31 August 2015). The primary objectives of the study were to evaluate the effect of patient characteristics on clinical response and overall survival (OS). Among 400 included patients (median age 66 years), the majority (83%) received nivolumab as second- or subsequent-line therapy. The median durations of progression-free survival and OS were 3.3 and 14.1 months, respectively, and 31.6% of patients achieved an objective response with a median duration of 20.1 months (range: 0-34.7). The safety profile of nivolumab was manageable and consistent with those of previous clinical trials, with an incidence of grade 3-5 adverse events of 13.8%. The safety and effectiveness of nivolumab in patients with advanced melanoma in real-world clinical practice in France were in line with the data reported in the Phase 3 trials CheckMate 066 and 037 of nivolumab in this patient population.

Published
2021

3. Comment on ‘Cutaneous manifestations in COVID‐19: a first perspective’ by Recalcati S

Author

F. Cazenave-Roblot, E. Hainaut, M. Masson Regnault, M. Hedou, F. Carsuzaa, E. Chary, Département de Dermatologie [CHU Poitiers], Centre hospitalier universitaire de Poitiers (CHU Poitiers), Médecine Interne et Maladies Infectieuses, CHU de Poitiers, Poitiers, France, Pharmacologie des anti-infectieux (PHAR), Université de Poitiers-Institut National de la Santé et de la Recherche Médicale (INSERM), and Chauzy, Alexia

Subjects
medicine.medical_specialty, skin, Coronavirus disease 2019 (COVID-19), Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), [SDV]Life Sciences [q-bio], Pneumonia, Viral, Anosmia, COVID‐19 infections, Dermatology, Skin Diseases, Letter to Editor, Betacoronavirus, 030207 dermatology & venereal diseases, 03 medical and health sciences, 0302 clinical medicine, Pandemic, Humans, Medicine, Letters to Editor, Pandemics, rhinorrhea, SARS-CoV-2, business.industry, COVID-19, Outbreak, [SDV.SP]Life Sciences [q-bio]/Pharmaceutical sciences, 3. Good health, Dysgeusia, [SDV] Life Sciences [q-bio], [SDV.SP] Life Sciences [q-bio]/Pharmaceutical sciences, Cutaneous manifestations, Infectious Diseases, Chinese city, 030220 oncology & carcinogenesis, medicine.symptom, Coronavirus Infections, business
Abstract

International audience; Since the coronavirus disease 2019 (COVID 19) outbreak was first reported in the Chinese city of Wuhan on December 31, 2019, it has stricken more than 1,000,000 persons worldwide, of whom over 50,000 have died (1). Having been infected by severe acute respiratory syndrome coronavirus 2 (SARS‐COV‐2), patients with COVID‐19 mainly present with fever and respiratory symptoms (2). Isolated sudden onset anosmia has also frequently been reported (3). Less frequently, rhinorrhea, diarrhoea and dysgeusia may be associated. While only a few reports have evoked cutaneous manifestations (4), we read with interest an initial study on the topic entitled “Cutaneous manifestations in COVID‐19: a first perspective ” by Recalcati S. (5).

Published
2020
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5. Efficacy and tolerance of photodynamic therapy for vulvar Paget's disease: a multicentric retrospective study

Author

Gaëlle Quéreux, Mahtab Samimi, Diane-Iris Rioli, Ludovic Martin, E. Hainaut, Laurent Misery, Nathalie Beneton, Département de Dermathologie [CHRU Tours], Centre Hospitalier Régional Universitaire de Tours (CHRU Tours), Infectiologie et Santé Publique (UMR ISP), Institut National de la Recherche Agronomique (INRA)-Université de Tours (UT), Anti-Tumor Immunosurveillance and Immunotherapy (CRCINA-ÉQUIPE 3), Centre de Recherche en Cancérologie et Immunologie Nantes-Angers (CRCINA), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Nantes - UFR de Médecine et des Techniques Médicales (UFR MEDECINE), Université de Nantes (UN)-Université de Nantes (UN)-Centre hospitalier universitaire de Nantes (CHU Nantes)-Centre National de la Recherche Scientifique (CNRS)-Université d'Angers (UA)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Nantes - UFR de Médecine et des Techniques Médicales (UFR MEDECINE), Université de Nantes (UN)-Université de Nantes (UN)-Centre hospitalier universitaire de Nantes (CHU Nantes)-Centre National de la Recherche Scientifique (CNRS)-Université d'Angers (UA), Centre Hospitalier Le Mans (CH Le Mans), Centre Hospitalier Universitaire d'Angers (CHU Angers), PRES Université Nantes Angers Le Mans (UNAM), Physiopathologie Cardiovasculaire et Mitochondriale (MITOVASC), Université d'Angers (UA)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Service de dermatologie (Dermato - BREST), Centre Hospitalier Régional Universitaire de Brest (CHRU Brest), Clinical and Translational Research in Skin Cancer (CRCINA-ÉQUIPE 2), Service de dermatologie [Nantes], Université de Nantes (UN)-Centre hospitalier universitaire de Nantes (CHU Nantes), Centre d’Investigation Clinique de Nantes (CIC Nantes), Université de Nantes (UN)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre hospitalier universitaire de Nantes (CHU Nantes), Centre Hospitalier Régional Universitaire de Tours (CHRU TOURS), and Institut National de la Recherche Agronomique (INRA)-Université de Tours

Subjects
medicine.medical_specialty, vulvar disease, vulvar Paget's disease, [SDV]Life Sciences [q-bio], Pain, Imiquimod, Dermatology, Disease, Malignancy, extra-mammary Paget's disease, 030207 dermatology & venereal diseases, 03 medical and health sciences, 0302 clinical medicine, Pain assessment, medicine, Humans, Neoplasm Invasiveness, Aged, Retrospective Studies, Aged, 80 and over, Photosensitizing Agents, Vulvar Neoplasms, non-surgical treatment, business.industry, Standard treatment, Retrospective cohort study, Aminolevulinic Acid, Middle Aged, medicine.disease, 3. Good health, Paget Disease, Extramammary, Treatment Outcome, photodynamic therapy, Photochemotherapy, 030220 oncology & carcinogenesis, Adenocarcinoma, Female, Neoplasm Recurrence, Local, business, [SDV.MHEP.DERM]Life Sciences [q-bio]/Human health and pathology/Dermatology, Progressive disease, Follow-Up Studies, medicine.drug
Abstract

International audience; BACKGROUND: Extra-mammary Paget's disease is a rare form of intraepithelial adenocarcinoma with a variable pattern of invasion, sometimes associated with distant malignancy. Vulvar Paget's disease (VPD) represents 1% of all vulvar cancers. Standard treatment is surgical excision, however, the recurrence rate is high and surgery leads to anatomical, functional, and sexual morbidity. Some case series suggest efficacy of photodynamic (PDT) as treatment for this indication.OBJECTIVES: Our aim was to assess the efficacy and tolerance of PDT in women suffering from VPD.MATERIALS & METHODS: A retrospective study was conducted on all patients suffering from VPD, treated with PDT at six hospitals in France. Clinical data, histopathological reports at diagnosis, therapeutic history, PDT schedule, tolerance, and clinical response were reported.RESULTS: Thirteen women were included, with a mean age of 70.1 years. Ten women had an in situ disease, two had CONCLUSION: PDT appears to be a therapeutic option for patients with VPD, with a response rate similar to that of other therapies usually recommended, such as surgery and imiquimod. There is a need to harmonise PDT procedures and pain assessment.

Published
2018

6. [Sclerodermatous changes revealing porphyria cutanea tarda]

Author

A, Brunet and E, Hainaut

Subjects
Porphyria Cutanea Tarda, Scleroderma, Localized, Porphyrins, Mutation, Humans, Female, Middle Aged, Hemochromatosis Protein
Abstract

Porphyria cutanea tarda (PCT) is associated with cutaneous accumulation of porphyrins. This accumulation results from a deficiency of uroporphyrinogen decarboxylase occurring only in the liver. The classical presentation is blistering on sun-exposed areas.A 59-year-old woman presented at the dermatology consultation for sclerotic lesions that had been present for one year. The remainder of the clinical examination and further investigations did not indicate systemic scleroderma. The sun-exposed nature of the lesions led us to perform an assay of urinary porphyrin, which was found to be elevated. Uroporphyrinogen decarboxylase levels were normal, confirming the diagnosis of type 1 PCT. Screening for a hepatic etiology revealed a heterozygous mutation H63D/C282Y of the hemochromatosis gene responsible for this clinical picture. The patient underwent regular bleeding, which led to complete disappearance of cutaneous sclerosis.Sclerodermatous lesions are an unusual presentation of PCT and cause delays in diagnosis. The accumulation of uroporphyrins in the dermis stimulates fibroblasts, which then synthesize collagen, resulting in cutaneous sclerosis.

Published
2017

7. Efficacy of etoposide for myelodysplasia cutis

Author

Eric Frouin, Mathieu Puyade, Diane-Iris Rioli, Amélie Walter, and E. Hainaut

Subjects
Male, 0301 basic medicine, medicine.medical_specialty, Skin Neoplasms, Treatment outcome, Cutis, Administration, Oral, Dermatology, Severity of Illness Index, Drug Administration Schedule, 03 medical and health sciences, Humans, Medicine, Etoposide, Aged, 80 and over, Dose-Response Relationship, Drug, business.industry, Pruritus, Biopsy, Needle, Follow up studies, Antineoplastic Agents, Phytogenic, Immunohistochemistry, Treatment Outcome, 030104 developmental biology, Myelodysplastic Syndromes, business, Follow-Up Studies, medicine.drug
Published
2018

8. A high neutrophil-to-lymphocyte ratio as a potential marker of mortality in patients with Merkel cell carcinoma: A retrospective study

Author

Mahtab Samimi, Thibault Kervarrec, Nathalie Beneton, Eric Estève, Martine Avenel-Audran, Antoine Touzé, E. Hainaut, Laurent Machet, François Aubin, J. Zaragoza, Service de Dermatologie, Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier), Université Francois Rabelais [Tours], Service de Pathologie, Hôpital René HUGUENIN (Saint-Cloud)-Institut Curie, Infectiologie Animale et Santé Publique - IASP (Nouzilly, France), Institut National de la Recherche Agronomique (INRA), PRES Université Nantes Angers Le Mans (UNAM), Service der Dermatologie, Centre hospitalier universitaire de Poitiers (CHU Poitiers), Université de Franche-Comté (UFC), project POCAME (Polyomavirus et Carcinome de Merkel) - Canceropole Grand Ouest-Region Centre Val de Loire (France), Hôpital René HUGUENIN (Saint-Cloud)-Institut Curie [Paris], Infectiologie et Santé Publique (UMR ISP), Institut National de la Recherche Agronomique (INRA)-Université de Tours (UT), Université Bourgogne Franche-Comté [COMUE] (UBFC), Institut Curie [Paris]-Hôpital René HUGUENIN (Saint-Cloud), and Institut National de la Recherche Agronomique (INRA)-Université de Tours

Subjects
0301 basic medicine, Oncology, Male, neutrophile, Skin Neoplasms, Neutrophils, [SDV]Life Sciences [q-bio], neoplasms, carcinome, Cohort Studies, Leukocyte Count, 0302 clinical medicine, Merkel cell carcinoma, cellule de merkel, malignant epithelial, prognostic factor, T-lymphocytes, Hazard ratio, food and beverages, Middle Aged, Prognosis, 3. Good health, Survival Rate, absolute lymphocyte count, 030220 oncology & carcinogenesis, Absolute neutrophil count, Female, Adult, medicine.medical_specialty, pronostic, specific survival, Dermatology, lymphocyte, Risk Assessment, Disease-Free Survival, 03 medical and health sciences, Internal medicine, medicine, Biomarkers, Tumor, Humans, Neoplasm Invasiveness, Lymphocyte Count, Neutrophil to lymphocyte ratio, Aged, Neoplasm Staging, Proportional Hazards Models, Retrospective Studies, Analysis of Variance, Performance status, Proportional hazards model, business.industry, fungi, absolute neutrophil count, Retrospective cohort study, medicine.disease, Confidence interval, Surgery, Carcinoma, Merkel Cell, 030104 developmental biology, blood neutrophil-to-lymphocyte ratio, Multivariate Analysis, indicateur mortalité, Neoplasm Recurrence, Local, business
Abstract

Background The prognostic relevance of a high blood neutrophil-to-lymphocyte ratio (NLR) has been reported in many cancers, although, to our knowledge, not investigated in patients with Merkel cell carcinoma (MCC) to date. Objective We assessed whether the NLR at baseline was associated with specific survival and recurrence-free survival in MCC. Methods We retrospectively included MCC cases between 1999 and 2015 and collected clinical data, blood cell count at baseline, and outcome. A Cox model was used to identify factors associated with recurrence and death from MCC. Results Among the 75 patients included in the study, a high NLR at baseline (NLR ≥4) was associated with death from MCC in univariate (hazard ratio 2.76, 95% confidence interval 1.15-6.62, P = .023) and multivariate (hazard ratio 3.30, 95% confidence interval 1.21-9.01, P = .020) analysis, but not with recurrence. Limitations Because of the retrospective design, we excluded patients with missing data and not all confounding factors that may influence the NLR were available. Conclusion A high NLR at baseline was independently associated with specific mortality in patients with MCC. The NLR seems to constitute an easily available and inexpensive prognostic biomarker at baseline.

Published
2016

9. [Uncommon cutaneous presentation of visceral Leishmaniasis associated with HIV]

Author

C, Cossart, G, Le Moal, M, Garcia, E, Frouin, E, Hainaut-Wierzbicka, and F, Roblot

Subjects
Biopsy, Humans, Leishmaniasis, Visceral, Female, HIV Infections, Exanthema, Middle Aged, Purpura, Skin
Abstract

Visceral leishmaniasis is not normally expressed in skin. Herein, we describe the case of an HIV-positive patient who developed two unusual skin manifestations during an episode of visceral leishmaniasis.A 48-year-old female patient consulted initially for infiltrated purpura of all four limbs. Skin biopsy revealed leukocytoclastic vasculitis with Leishman-Donovan bodies. Laboratory tests showed medullary, splenic, gastric and colic involvement, suggesting systemic disease, and enabling visceral leishmaniasis to be diagnosed. Two years later, despite prolonged treatment, the patient presented maculopapular exanthema, and histology revealed persistent Leishman-Donovan bodies.We report herein an association of two rare skin manifestations in an HIV-positive patient with visceral leishmaniasis: infiltrated purpura and maculopapular exanthema. However, the underlying mechanisms remain hypothetical. The initial leukocytoclastic exanthema could be secondary to either polyclonal hypergammaglobulinaemia or to IgA deposits, or possibly to mechanical impairment of blood vessels by the actual parasite. The maculopapular exanthema occurring later raised the possibility of post-Kala-Azar leishmaniasis due to blood-borne dissemination in an anergic subject or perhaps even immune reconstitution inflammatory syndrome.

Published
2015

10. [Dermato-neuro syndrome during scleromyxedema: efficacy of plasmapheresis and intravenous immunoglobulin]

Author

S, Charles, E, Hainaut, V, Cante, C, Valette, P, Levillain, and G, Guillet

Subjects
Neurocutaneous Syndromes, Scleromyxedema, Remission Induction, Humans, Immunoglobulins, Intravenous, Female, Plasmapheresis, Middle Aged, Combined Modality Therapy
Abstract

Dermato-neuro syndrome is a specific neurological complication of scleromyxedema presenting with fever, coma, seizures and flu-like syndrome. To our knowledge, it has only been reported about twenty times in the literature. Its outcome is uncertain. We describe the case of a patient in whom a favorable outcome was achieved using a combination of plasmapheresis and intravenous immunoglobulin (IVIG).A 57-year-old woman was diagnosed 14 years ago with scleromyxedema resistant to multiple lines of treatment. In November 2011, she presented an initial episode of epileptic seizure followed by post-seizure coma, and later, confusional state with visual hallucinations. She recovered spontaneously within a few days. CT scan, MRI, EEG and screening for infection were perfectly normal, resulting in suspicion of neurological involvement associated with her scleromyxedema. In December 2012 and August 2013, she presented two further episodes of status epilepticus, followed once more by a confusional state, with etiological explorations again proving unfruitful. On this occasion, her confusional state persisted for two months until the initiation of plasmapheresis and IVIG. This combination therapy led to rapid regression of all neurological symptoms and an improvement in her general condition.The dermato-neuro syndrome is a rare neurological complication of scleromyxedema. Its pathophysiology is unknown. The monoclonal gammopathy induced by the scleromyxedema could account for the patient's hypercoagulable state and for the formation of neutrophilic aggregates leading to impaired microcirculation. Treatment is empirical and poorly codified. The course of the disease is unpredictable and may be lethal.

Published
2013

11. [Severe skin reaction with mucous membrane inflammation during MINE chemotherapy]

Author

M, Camus, E, Hainaut-Wierzbicka, P, Levillain, J-P, Saulnier, L, Lopez, and G, Guillet

Subjects
Mucositis, Panniculitis, Adolescent, Hodgkin Disease, Glossitis, Hyperalgesia, Antineoplastic Combined Chemotherapy Protocols, Edema, Humans, Female, Drug Eruptions, Ifosfamide, Mitoxantrone, Etoposide, Mesna
Abstract

MINE chemotherapy is used to treat refractory Hodgkin's disease. Cutaneous adverse effects of MINE regimen are uncommon and chiefly consist of erythema and oedema of the extremities. More recently, a number of cases of panniculitis and subcutaneous inflammatory oedema have been described.We report the case of a 17-year-old girl developing acute and painful oedema of the limbs with panniculitis of the trunk. This incident was associated with inflammatory lesions of mucous membrane, in particularly in the genital area and on the tongue. These signs occurred 7 days after initiation of MINE chemotherapy, with no other drugs being introduced. A drug-induced reaction was suspected due to the absence of any other aetiology, particularly infectious disease. The condition gradually improved with symptomatic pain therapy. The patient's chemotherapy was subsequently modified.The chronology of the symptoms, spontaneous improvement after the end of treatment, and the absence of other potential causative factors resulted in a hypothesis of a cutaneous adverse reaction to the MINE regimen. The signs could be due to capillary leak syndrome resulting from the toxicity of vinorelbine on endothelial cells. Dermatologists should be aware of these cutaneous adverse effects and of the inflammatory lesions of mucous membrane newly described herein.

Published
2010

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