François-Xavier Lescure

To assess the incidence and risk factors for severe liver toxicity in human immunodeficiency virus (HIV) infected patients on anti-tuberculosis treatment and the impact of patients' characteristics and concomitant medications instituted during the first week of antituberculosis treatment. HIV-infected patients referred to six French hospitals between 1 January 1992 and 31 December 2004, with confirmed or 'presumptive' tuberculosis (TB). Liver toxicity was studied during the first 2 months of TB treatment. During the 12 years of the study period, 144 patients were enrolled. Severe liver toxicity developed in 15 (10.7%). The median time to development of liver toxicity was 14 days. In the univariate analysis, high baseline bilirubin levels (P = 0.004), CD4 cell counts between 50 and 100 cells/mm3 (P = 0.022) and the use of fluconazole (P = 0.0005) were associated with liver toxicity. In the multivariate analysis, independent risk factors were abnormal baseline alanine aminotransferase (ALT) (P = 0.028) and bilirubin levels (P = 0.033) and the use of fluconazole (P = 0.008). Severe liver toxicity is frequent, and occurs early in the course of anti-tuberculosis treatment. ALT and bilirubin levels should be closely monitored during the first month of treatment, especially in patients with high baseline ALT or bilirubin levels. We suggest caution when prescribing fluconazole and anti-tuberculosis drugs concomitantly, although this needs to be confirmed and further investigated.

The aim of this cross-sectional multicenter study was to determine the prevalence of and risk factors for hypothyroidism in human immunodeficiency vi

French Guyana is an endemic area for American cutaneous leishmaniasis. At the start, the initial red lesion may be mistaken for a whitlow. Twenty percent of developed forms exhibit a sporotrichosis pattern. The notion of travel to an endemic area is very important for diagnosis. We report the case of a young man from French Guyana presenting with a cutaneous lesion of the finger. After numerous surgical treatments for a "whitlow", the final diagnosis of leishmaniasis was difficult because of local-complications and cutaneous rearrangement. Erroneous initial orientation in a unit unaware of tropical diseases can forestall appropriate care of the patients. Epidemiological, clinical and therapeutic data on American tegument leishmaniasis are discussed.