[Acrodystrophic neuropathy of Bureau and Barrière].
BACKGROUND
The acrodystrophic neuropathy described by Bureau and Barrière in the 1950s is a rare trophic complication of chronic, analgesic neuropathy due to alcohol abuse, which is at the origin of perforating ulcers of the foot, vasomotor disorders with dysautonomia, and leads to mutilating arthropathy of the lower limb. This neuroacropathy, also termed vagabonds' or vagrants' disease, usually occurs in subjects with a debilitated condition, chronic alcoholism, and unfavourable socioeconomic conditions.


METHODS
We report four cases of Bureau-Barrière disease which occurred in male subjects who were on average 55 years of age. The clinical presentation was close to that reported in the literature. Indeed, all four patients were alcoholic, nondiabetic and lived under conditions of precarious hygiene. Therapeutic management of the patients was difficult due to bad compliance with the treatment and persistence of alcohol abuse. Immobilization of the foot is considered to be the primary treatment. Local care including baths and bandages with hydrocolloids must be continued during several months, and associated with antibiotic therapy, administered by infusion when necessary. The outcome is often chronic, with poor prognosis. Given the limited therapeutic possibilities, acrodystrophic neuropathy is an invalidating disease with high morbidity.


CONCLUSIONS
Bureau-Barrière disease is a rare, serious invalidating disease. The clinical symptomatology is usually based on the diagnostic triad: analgesia of the foot, perforating ulcers of the foot, and deforming and mutilating arthropathy of the lower limb. Treatment is often hampered due to poor compliance with local care and persistence of alcohol abuse.
Dilhuydy
M S
MS
Clinique de médecine interne et maladies infectieuses, Hôpital Haut-Lévêque, CHU de Bordeaux, Pessac, France.
Mercié
P
P
Doutre
M S
MS
Viallard
J F
JF
Faure
I
I
Ellie
E
E
Beylot
C
C
Leng
B
B
Pellegrin
J L
JL
D000437:Alcoholism / Q000150:complications*; D005531:Foot Deformities, Acquired / Q000209:etiology* / Q000473:pathology; D016523:Foot Ulcer / Q000209:etiology* / Q000473:pathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D010523:Peripheral Nervous System Diseases / Q000209:etiology* / Q000473:pathology; D013577:Syndrome