Chronic tophaceous gout with unusual large tophi: case report

Gout is a metabolic disease, which is characterized by acute or chronic arthritis, and deposition of monosodium urate crystals in joint, bones, soft tissues, and kidneys. But large tophi are unusual in chronic gout. We report the case of a 67-year-oldArabman presenting chronic tophaceous gout with unusual large tophi involving multiple joints: hands, feet, elbows, and knees. Laboratory workup revealed elevated serum uric acid (96 mg/l, normal: 20-74 mg/l), with normal renal function test. In untreated patients, chronic tophaceous gout may develop, which is characterized by chronic destructive polyarticular involvement and tophi. The treatment consists to decrease serum uric acid level which eventually allows the regression of tophi.Pan African Medical Journal 2015; 2

Spondylarthrite ankylosante et maladie de Still: un lien physiopathologique ou une simple association?

La spondylarthrite ankylosante est un rhumatisme inflammatoire chronique,qui fait partie des groupes de spondyloarthrites, au cours duquel les signes généraux comme la fièvre et l'amaigrissement sont peu importants. La maladie de Still de l'adulte est une affection systémique rare, qui reste un diagnostic d'élimination, et qui associe classiquement une fièvre élevée hectique, une éruption cutanée, des arthrites, et des manifestations systémiques diverses. Peu de cas de spondylarthrites ankylosantes présentés avec un tableau de la maladie de Still de l'adulte ont été décrits dans la littérature. Nous rapportons un nouveau cas d'un patient de 31ans suivi pour spondylarthrite ankylosante et qui se présente avec une fièvre au long cours et des signes clinico-biologiques entrant dans le cadre de la maladie de Still de l'adulte. Un éventuel lien physiopathologique entre les deux pathologies peut être évoqué, même si leur survenue simultanée est rarement rapportée dans la littérature

Multifocal osteoarticular tuberculosis and pleuropulmonary involvement in an immunocompetent patient

Introduction: Multifocal tuberculosis is an uncommon presentation in immune-competent patients; it’s associated more with an immune-depression like HIV (Human Immunodeficiency Virus) infection. Here, we are presenting unusual multifocal osteoarticular localizations including the wrist and tarsal joint which are rare and pleura-pulmonary tuberculosis. Case presentation: Wrist, ankle, tarsal joint, hip and lung involvement was detected in a 30 year-old male patient. Mycobacterium tuberculosis was isolated from both synovial and pleural biopsy specimen cultures. The treatment was based on 9 months of antituberculosis drugs: rifampin (RMP), isoniazid (INH), pyrazinamide (Z) and ethambutol (EMB). INH (300 mg/day), RMP (600 mg/day), PZA (3gr/day) and EMB (1200 mg/day) were given for treatment 6 days/7. In the 4th week the patient’s condition improved and was discharged. After two months, the therapy was continued with INH and RMP up to 9 months. A hip replacement surgery and wrist Arthrodesis will be discussed after the patient’s total healing. Conclusion: Tuberculous osteoarthritis is a frequently missed diagnosis, especially in different clinical patterns. A high level of suspicion is required particularly in high-risk populations and endemic areas. Well conducted treatment improves the prognosis

Myositis ossificans progressive: case report

Myositis ossificansprogressiva (MOP) is an autosomal dominant disorder. There is a progressive ectopic ossification and skeletal malformation, mainly in the connective tissue of muscle. The diagnosis is based on the clinical findings and radiological demonstration of the skeletal malformations. A 38-year-old female patient was admitted to our department with progressive increase of the thigh. Results of laboratory studies were normal . The radiography of the right thigh showed multiple intramuscular calcifications. Myositis ossificansprogressiva should be diagnosed as early as possible and non-invasively, based upon history, clinical and radiological findings. Early and correct diagnosis is fundamental for indication of proper management of the disease. Key words: myositis ossificans progressive, ossification, ectopic bone.The Pan African Medical Journal 2016;2

Ankylosing spondylitis associated with Sweet’s syndrome: a case report

<p>Abstract</p> <p>Introduction</p> <p>Sweet’s syndrome is an acute neutrophilic dermatosis characterized by a diffuse dermal infiltrate of mature neutrophils. In most cases, it occurs as an isolated phenomenon (idiopathic Sweet’s syndrome) but it can be drug induced or associated with a variety of underlying diseases such as infections, neoplasms, and chronic inflammatory diseases. The association between Sweet’s syndrome and ankylosing spondylitis is rare. Only a few cases have been reported in the literature. We report a new case in which we describe an outbreak of acute neutrophilic dermatosis revealing ankylosing spondylitis.</p> <p>Case presentation</p> <p>A 33-year-old Moroccan man presented with large-joint polyarthralgia, inflammatory pain in his buttocks and lower lumbar spine, fever and skin lesions. On examination, the patient had a low-grade fever, six tender but not swollen joints, limitation of motion of the lumbar spine, and painful erythematous maculopapules over his face, neck, and hands. Laboratory tests showed hyperleukocytosis, and elevated erythrocyte sedimentation rate and C-reactive protein. The immunological tests and infectious disease markers were negative. Investigations for an underlying neoplastic disease remained negative. Magnetic resonance imaging showed a bilateral sacroiliitis. Skin biopsy findings were consistent with Sweet’s syndrome. The diagnosis of Sweet’s syndrome associated with ankylosing spondylitis was established. Nonsteroid anti-inflammatory drugs were started and the patient showed rapid clinical and biological improvement.</p> <p>Conclusion</p> <p>Three observations of the association between Sweet’s syndrome and spondylarthropathy have been reported in the literature. The cause of this association remains unclear. Some hypotheses have been developed, but further studies are needed to confirm or refute them.</p