Pyoderma gangrenosum avec localisations pulmonaires traité par infliximab

• Autores: D. Deregnaucourt, S. Buche, S. Coopman, D. Basraoui, D. Turck, E. Delaporte
• Localización: Annales de dermatologie et de véneréologie, ISSN 0151-9638, Vol. 140, Nº. 5, 2013, págs. 363-366
• Idioma: francés
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• Resumen

  • Résumé Introduction Le pyoderma gangrenosum (PG) est une dermatose neutrophilique souvent associée à des maladies systémiques, notamment aux maladies inflammatoires chroniques de l'intestin. Des localisations extracutanées (articulaires, oculaires, rénales, pulmonaires, hépatospléniques ou musculaires) existent. Parmi celles-ci, l'atteinte pulmonaire est la plus fréquente.

    Observation Nous rapportons un cas de PG avec localisations cutanées et pulmonaires survenu dans un contexte de rectocolite hémorragique (RCH) sévère déjà traitée par corticothérapie orale à forte dose. Des localisations pulmonaires de ce PG ont été découvertes lors du bilan systématique réalisé avant l'instauration des anti-TNF?. L'infliximab a permis une régression rapide des lésions cutanées et pulmonaires.

    Discussion Des lésions pulmonaires évocatrices d'abcès, évoluant parallèlement à des lésions cutanées de PG, doivent faire évoquer une atteinte viscérale spécifique. Le traitement de première intention est la corticothérapie orale. Chez notre malade, la survenue des lésions sous corticoïdes dans le cadre d'une RCH a posé l'indication d'un traitement par anti-TNF?, qui s'est montré efficace.

    ________________________________________ Summary Background Pyoderma gangrenosum (PG) is a rare neutrophilic dermatosis often associated with systemic diseases, particularly chronic inflammatory bowel diseases. Extracutaneous manifestations (articular, ocular, renal, pulmonary, hepatosplenic, muscular) exist, with lung involvement being the most common.

    Patient and methods We report a case of PG with skin and lung involvements in a patient treated with high-dose corticosteroids in a setting of severe ulcerative colitis (UC). Lung involvement was diagnosed during the pretreatment assessment performed prior to initiation of anti-TNF? therapy. Infliximab resulted in rapid improvement of the lung and skin lesions.

    Discussion In the event of simultaneous cutaneous PG lesions and lung lesions suggestive of abscess, visceral involvement should be suspected. First-line treatment consists of oral corticosteroids. In our patient, the occurrence of lesions under corticosteroids in UC militated in favour of anti-TNF? therapy, which proved effective.

    Mots clés " Pyoderma gangrenosum;

    " Infliximab;

    " Rectocolite hémorragique Keywords " Pyoderma gangrenosum;

    " Infliximab;

    " Ulcerative colitis ________________________________________ Les effets indésirables cutanés des inhibiteurs de mTOR sont fréquents et leur retentissement sur la qualité de vie particulièrement marqué pour le domaine physique. Une prise en charge précoce de ces effets indésirables par un dermatologue serait souhaitable pour améliorer la qualité de vie des patients.

    ________________________________________ Summary Background Mammalian target of rapamycine (mTOR) inhibitors are being increasingly prescribed as antitumoural drugs, and associated adverse cutaneous effects are frequent but poorly described. The aim of this study was to describe such adverse effects and to assess the quality of life of patients experiencing them.

    Patients and methods Over a period of 18 months, 18 patients treated with mTOR inhibitors for renal carcinoma were included and 77 dermatological examinations performed. Wherever a cutaneous adverse event was present, quality of life was evaluated using the Skindex 30 questionnaire.

    Results Fifteen of the 18 patients included presented adverse cutaneous events, consisting of buccal ulcers (61.1%), xerosis (55.5%), distal onycholysis (50%), acneiform eruption (38.8%), paronychia (22.2%) and pruritus (22.2%). Buccal ulcerations and perionyxis had an especially marked impact on quality of life, which was greatest in terms of physical score (19%), followed by emotional (9%) and functional (6%) scores.

    Conclusion Cutaneous adverse effects of mTOR inhibitors are frequent and have a considerable impact on quality of life, particularly as regards physical scores. Dermatological examination appears useful to allow early management of cutaneous adverse effects and improve the quality of life of these patients.

    Mots clés " Inhibiteurs de mTOR;

    " Effets indésirables cutanés;

    " Qualité de vie;

    " Skindex 30 Keywords " Mammalian target of rapamycine inhibitors;

    " Cutaneous side effects;

    " Quality of life;

    " Skindex 30 ________________________________________