Bone metastasis as the first sign of gastric cancer

The skeleton is a common metastatic site for visceral carcinomas. However, the presentation of gastric cancer as bony metastases without preceding gastrointestinal symptoms is rare which has been infrequently reported in the literature. We report an infrequent case of a 60-year-old patient diagnosed having a gastric carcinoma with bone metastasis as the first evidence. She has consulted with worsening backache which started two months priorly

Pneumomédiastin au cours d’une dermatomyosite, une entité rare: à propos d’un cas

la dermatomyosite est une connective caractérisée par une inflammation du muscle squelettique associée à des manifestations cutanées caractéristiques. Leurs étiologies, encore méconnues, associent facteurs environnementaux et génétiques. Parmi les complications pulmonaires décrites, les pneumopathies interstitielles qui sont des complications fréquentes. D'autres complications sont plus rarement rapportées comme le pneumomédiastin. Nous rapportons une observation de pneumomédiastin avec dissection aérique sous cutanée massive survenus chez une patiente atteinte de dermatomyosite. Nous discutons, à la vue des données de la littérature de la fréquence, des causes et des mécanismes physiopathologiques de cette pathologie.Pan African Medical Journal 2016; 2

Atlantoaxial instability: An exceptional complication of ankylosing spondylitis

Background: Atlantoaxial instability (AAI) and more rarely odontoid pannus formation, similar to the one observed in Rheumatoid Arthritis, are seldom reported in ankylosing spondylitis (AS). We report a new case of a patient with AS with a pannus in the atlanto-axial region and cervical C1-C2 instability. Case presentation: The patient, now aged 41, was diagnosed with AS in 2010. She was put on different non steroidal anti inflammatory treatments with persistent spinal pain. She was referred to our department in 2015 with severe cervical pain and stiffness since 3 months. On examination, the patient had severely limited cervical spine movements. Lumbar spine movements were moderately affected. There was no neurological deficit. Her Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) was 4.9/10 and Bath Ankylosing Spondylitis Functional Index (BASFI) was 5/10. Plain Radiographs of the pelvis showed bilateral grade 4 sacroilitis and bilateral coxitis. Dorsal and lumbar spine plain radiographs showed squaring of vertebral bodies. Cervical spine radiographs showed an increased atlanto-axial distance. Spinal MRI confirmed the atlantoaxial subluxation with an anterior distance of 8 mm, with marked intraspinal pannus formation and synovitis around the odontoid peg. Synovial thickening exerted an anterior mark on the bulbo-medullary junction with no evidence of oedema signs. Posterior zygapophysial ankylosis involving all cervical levels was also observed. The patient had a cervical collar with anti-tumor necrosis factor-α (cerolizumab-pegol) prescription with favorable outcome. Conclusion: Odontoid pannus formation is rare in AS. Clinical and radiological follow-up are important to assess the impact on the cervical spine. Keywords: Ankylosing spondylitis, Atlantoaxial instability, MRI, Cerolizumab-pego

Complete form pachydermoperiostosis in Tunisia – A case series and literature review

Introduction: Pachydermoperiostosis (PDP) or hypertrophic osteoarthropathy (HOA) is a rare disease that has genetic predisposition and defined clinical features. Aim of the work: To study and analyse the clinical features of Tunisian PDP patients and review the literature. Patients and methods: The PDP cases attending the Rheumatology Department of the University Hospital Farhat Hached of Sousse in Tunisia were retrospectively studied over a period of 17 years (2000–2017). Secondary causes were excluded. Results: The PDP cases had a primary and complete form of the disease and included 6 men at a frequency of 0.03% (6/20,000) of the total number of rheumatic diseases cases attending the rheumatology clinic. The mean age was 27 ± 12.3 years [18–46 years]. Five patients had arthralgia and one polyarthritis. Thickening of the skin of the head and distal extremities (pachyderma) and deep folds and furrows of the skin of the forehead was observed in all cases. Digital clubbing of the fingers and toes and spade-like enlargement of the hands and feet was noted in 5 cases. Hyperhidrosis of the hands and feet was observed in 4 cases and seborrhea in 2. Elevated acute phase reactants were found in 4 cases. Hypergammaglobulinemia was present in one case. Periostosis of the long bones was observed in all cases. Treatment consisted of analgesics in all cases, non-steroidal anti-inflammatory drugs in 2 cases and tamoxifen in 2 cases. Conclusions: Complete form of primary PDP is rarely present among rheumatic diseases patients in Tunisia. A multicenter larger number longitudinal study is recommended. Keywords: Pachydermoperiostosis, Clubbing, Hypertrophic osteoarthropathy, Periostosi

Kallmann syndrome: MRI findings

Kallmann syndrome (KS) is a disease clinically characterized by the association of hypogonadotrophic hypogonadism and anosmia or hyposmia. It is a neuronal migration disorder. Magnetic resonance (MR) imaging is used to visualize the olfactory tracts and to evaluate the olfactory sulci. Five patients who clinically had hypogonadotrophic hypogonadism were examined by MR. Thin coronal images of the interior frontal region were used to determine presence or absence of olfactory tract and to evaluate the olfactory sulci