Disseminated Tuberculosis Mimicking Ankylosing Spondylitis

Ankylosing spondylitis is a chronic inflammatory disorder affecting mainly the axial skeleton. Here we report a case of a man with a clinical suspicion of ankylosing spondylitis but with a persistence of increased inflammatory markers. In this case, (18)F-FDG-PET/CT revealed multiple hypermetabolic lesions in axial skeleton, lymph nodes, and the lung, suggestive of either disseminated tuberculosis or lymphoma. Histological analysis of the pulmonary lesion revealed mycobacterium tuberculosis. This case highlights, firstly, the importance of excluding other diagnoses in the presence of clinical picture of ankylosing spondylitis and high inflammatory markers and, secondly, the determining role of PET/CT

Images in radiology. A bright spot.

Case ReportsJournal ArticleResearch Support, Non-U.S. Gov'tinfo:eu-repo/semantics/publishe

Maladie de Still de l’adulte : cause rare de fièvre prolongée

La maladie de Still de l’adulte est une cause rare de fièvre prolongée d’étiologie indéterminée. Sa symptomatologie clinique et ses manifestations biologiques sont polymorphes et peu spécifiques. Nous soulignerons l’intérêt du dosage de la ferritinémie couplée à la ferritine glycosylée. Le diagnostic de maladie de Still repose sur les critères de Yamaguchi : 3 critères majeurs présents (fièvre élevée depuis plus d’une semaine, hyperleucocytose neutrophile majeure, arthralgies diffuses) et 3 critères mineurs (augmentation des enzymes hépatiques sans évidence médicamenteuse ou toxique, adénopathies identifiées au Pet-scan et négativité des anticorps antinucléaires et des facteurs rhumatoïdes). La physiopathologie reste mal connue et le traitement s’appuie encore principalement sur les glucocorticoïdes par voie systémique. Nous discutons enfin l’intérêt des biothérapies, en particulier des antagonistes spécifiques du recepteur de l’IL-6

Artérite giganto-cellulaire : discussion clinique, paraclinique et thérapeutique

La maladie de Horton ou artérite giganto-cellulaire est une artérite qui affecte essentiellement les vaisseaux de grands calibres. Elle touche ainsi les territoires dépendants des branches de la carotide externe mais peut aussi atteindre l’oeil, le système nerveux central, le tube digestif, le système respiratoire, le système artériel des membres inférieurs, le coeur. Le diagnostic de confirmation s’appuie toujours sur la biopsie de l’artère temporale qui n’est cependant pas positive dans tous les cas. Le Pet-Scan prend une place de plus en plus importante dans l’arbre diagnostic en montrant une hyperfixation métabolique des grands et des moyens vaisseaux. Le traitement repose toujours sur les glucocorticoïdes par voie systémique. Toutefois, nous signalons la place progressivement croissante de biothérapies dont principalement les antagonistes spécifiques du récepteur de l’IL-6

Progressive osteoblastic bone metastases in breast cancer negative on FDG-PET.

Positron emission tomography using F-18 fluorodeoxyglucose positron emission tomography (FDG-PET) is increasingly used in breast cancer. The new generation cameras integrate PET and CT within the same camera, allowing the simultaneous assessment of the structural and metabolic aspects of disease. There is presently a controversy on the clinical significance of osteoblastic bone metastases in breast cancer which are not detected on FDG-PET. It has been suggested that these radiologically dense lesions represent the result of successful treatment of initially osteolytic lesions. We report a case of a 65-year-old woman with a suspicion of recurrent breast cancer based on an increasing serum tumor marker. Serial PET/CT showed progressive blastic bone metastases on the CT without FDG uptake. These lesions were confirmed by bone single photon emission computed tomography. This case report shows: first, that progressive osteoblastic lesions can lack FDG-avidity, leading to a false-negative PET; and secondly, that bone scintigraphy should not be replaced by FDG-PET/CT for the detection of bone metastases in breast cancer.Case ReportsJournal ArticleSCOPUS: ar.jinfo:eu-repo/semantics/publishe

Thiamazole pretreatment lowers the ¹³¹I activity needed to cure hyperthyroidism in patients with nodular goiter

Context: Relatively low radioiodine uptake (RAIU) represents a common obstacle for radioiodine (131I) therapy in patients with multinodular goiter complicated by hyperthyroidism. Objective: To evaluate whether thiamazole (MTZ) pretreatment can increase 131I therapeutic efficacy. Design and Setting: Twenty-two patients with multinodular goiter, subclinical hyperthyroidism, and RAIU 4 and free T3 concentrations decreased by 22% and 15%, respectively, whereas no changes in thyroid function were observed in the LID group. Thyroid volume did not significantly change in either of the two groups. At 12 months after radioiodine treatment, median serum TSH was within the normal range in both groups. Conclusions: MTZ treatment before 131I therapy resulted in an average 2-fold increase in thyroid RAIU and enhanced the efficiency of radioiodine therapy assessed at 12 months. MTZ pretreatment is therefore a safe, easily accessible alternative to recombinant human TSH stimulation and a more effective option than LID.SCOPUS: ar.jinfo:eu-repo/semantics/publishe

Heterogeneity of metabolic response to systemic therapy in metastatic breast cancer patients.

The aim of this retrospective study was to describe the intra-individual heterogeneity of the ¹⁸F-labelled fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) response among lesions in bone-dominant metastatic breast cancer patients treated with systemic therapies.Journal ArticleSCOPUS: ar.jinfo:eu-repo/semantics/publishe