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Annales de Dermatologie et de Vénéréologie
Vol 127, N° 4  - mai 2000
p. 393
Doi : AD-05-2000-127-4-0151-9638-101019-ART94
Cas clinique

Actinomycose cutanée péri-anale et fessière
 

A. Gayraud [1], C. Grosieux-Dauger [1], A. Durlach [2], V. Salmon-Ehr [1], A. Elia [3], E. Grosshans [4], P. Bernard [1]
[1] Service de Dermatologie, CHU Robert-Debré.
[2] Laboratoire d'Histologie, CHU Maison Blanche.
[3] Service de Chirurgie Générale et Viscérale, CHU Robert-Debré, 51092 Reims Cedex.
[4] Clinique Dermatologique, Hospices Civils, 67091 Strasbourg Cedex.

Abstract
Introduction

L'actinomycose est une suppuration chronique granulomateuse extensive, rare, responsable d'une atteinte cervico-faciale dans 50 à 60 p. 100 des cas. L'atteinte cutanée extra-cervicale est exceptionnelle.

Observations

Deux hommes, âgés respectivement de 51 et 58 ans, étaient hospitalisés pour des placards érythémato-violacés nodulaires parsemés de fistules purulentes, péri-anales et fessières, évoluant depuis plusieurs mois, associés à une altération de l'état général. Les prélèvements bactériologiques (pus, biopsies) permettaient d'isoler Actinomyces meyeri dans le cas n o 1, et Actinomyces israelii dans le cas n o 2. La recherche d'extension était négative. La prise en charge était médico-chirurgicale dans le cas n o 1 et médicale dans le cas n o 2.

Discussion

Ces deux observations sont originales par leur similarité clinique et par la rareté de la souche isolée ( Actinomyces meyeri ) dans un cas. L'absence d'atteinte extra-cutanée suggère un mécanisme de contamination péri-anale par déglutition de la flore endobuccale.

Abstract
Cutaneous actinomycosis localized on the perianal area and buttocks.
Introduction

Actinomycosis is a rare spreading suppurative and granulomatous disease. In 50 to 60 p. 100 of cases, cervico-facial area is involved. Involvement of other cutaneous areas is very uncommon.

Case-reports

Two men (51 and 58 year-old, respectively) were admitted to the hospital because of erythematous and violaceous nodules with fistulization to the skin, localized on the perianal area and buttocks for several months. Bacterial cultures of the pus and of skin biopsy specimens yielded Actinomyces meyeri in case 1 and Actinomyces israelii in case 2. Patients did not have other infectious lesions. Treatment included systemic antibiotics and surgical iterative excisions in case 1.

Discussion

The main interest of those two cases is their similar clinical presentation and in one case the rarity of the micro-organism involved ( Actinomyces meyeri ). Since the lesions involved only the skin, we postulate that the organism may have extended from the oral mucosa through the gastrointestinal tract.






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