Erythème marginé de Besnier: manifestation rare au cours du rhumatisme articulaire aigu

This study reports the case of a 3-year old female child with a 1-year history of rash manifesting as discoid plaques with pink, non-itchy, rounded and oval, polycyclic, confluent macular areas measuring 1-3 cm in diameter, with central clearing evolving in stages, with repeated regression and reappearance. The child was admitted to the Emergency Department with respiratory distress, fever and aggravation of pre-existing skin lesions becoming diffuse. Mitral holosystolic murmur with an intensity of grade 4/6 was recorded by cardiac auscultation. Cardiac ultrasound showed acute massive mitral insufficiency with valvular vegetations. Laboratory tests showed inflammation with a CRP level of 300 mg/l and a sedimentation rate of 60 mm in the first hour and ASLO levels were very high (1600 IU/ml). The diagnosis of infectious endocarditis due to valvular rheumatic heart disease was retained. After stabilization, antibiotic therapy and mitral valve surgery in emergency, the dermatological lesions regressed in a few days but the haemodynamic condition of the child deteriorated rapidly with sudden death. Besnier erythema is a rare cutaneous manifestation of acute articular rhumatism. Physicians should not neglect this rare but useful clinical sign, especially in patients with subclinical valvular involvement in order to avoid potential late cardiac complications. The three differential diagnoses included: ringworm, urticaria, and erythema due to hereditary angioedema.