A rare form of pancreatic diabetes complicated by portal venous thrombosis: A 25-year follow-up

Fibrocalculous pancreatic diabetes (FCPD) is an uncommon type of diabetes mellitus, so called tropical diabetes, due to chronic calcific non-alcoholic pancreatitis. This type of diabetes is associated to several particularities based on glycemic control and the occurrence of degenerative and metabolic complications, in addition to chronic pancreatitis complications such us venous thrombosis. We report here a rare case of a young North-African patient with long standing FCPD followed for 25 years and complicated by portal venous thrombosis. This case presentation highlights how important is to suspect fibrocalculous pancreatic diabetes especially in the presence of chronic abdominal pain. The follow-up of such patients should be focused not only on the clinical and biological markers of diabetes, but also on pancreatitis complications

Etude sur le diabète aigu cétosique inaugural dans un hôpital du Centre-Est Tunisien

La cétose est une complication aiguë du diabète qui consiste en une accumulation de corps cétoniques sanguins. Malgré la haute prévalence du diabète cétosique décrite, il existe très peu d’informations concernant l’épidémiologie de cette complication inaugurale du diabète en Tunisie. L’objectif était de déterminer les caractéristiques épidémiologiques et clinico-biologiques des cétoses inaugurales dans un hôpital du Centre-Est tunisien. Il s’agit d’une étude rétrospective, transversale et exhaustive, à propos de patients admis pour une cétose inaugurale sur une période allant de janvier 2010 à août 2016. La population d’étude a été divisée en 2 groupes selon la présence ou pas d’une auto-immunité anti pancréatique: groupe DAI (diabète de type 1 auto-immun) regroupe tous les patients avec une auto-immunité, et le groupe DNAI (diabète cétosique non auto-immuns) sans auto-immunité. Il s’agit de 391 patients, de sex ratio 266 hommes/125 femmes, d’âge moyen de 34±14,33 ans. La prédominance masculine était nette: 68% dans la population générale. L’âge de la cétose était significativement plus précoce dans le groupe DAI. Un facteur précipitant la cétose était retrouvé chez 77,7% de la population globale d’étude, significativement plus fréquent dans le groupe DAI que dans le groupe DNAI. Le facteur le plus retrouvé était les infections virales. Les Anticorps anti thyroïdiens étaient significativement importants dans le groupe DAI. La cétose est un facteur de décompensation inaugurale fréquent du diabète en Tunisie. La population la plus importante a été décrite chez l’adulte jeune masculin, avec l’absence d’une auto-immunité, et un profil clinique du diabète de type 2

Micro adénome à prolactine à l’âge de la ménopause

L'adénome à prolactine est rare chez la femme âgée. Le tableau clinique peut être confondu avec les manifestations de la ménopause, rendant son diagnostic parfois difficile. Nous rapportons une observation sur les particularités d'un micro adénome à prolactine survenant chez une femme âgée de 57 ans, qui a présenté une aménorrhée secondaire sans bouffées de chaleur associée à une galactorrhée évoluant depuis 2 ans. L’examen physique confirme la galactorrhée et la biologie montre une hyperprolactinémie à 2735 mUI /L, FSH = 15,1 UI/L et LH = 4,1UI/L. L’IRM hypophysaire montre un adénome gauche de 8mm. L'évolution sous traitement dopaminergique était marqué par la reprise transitoire des cycles et apparition de bouffées de chaleur, normalisation de la prolactinémie et diminution de la taille de l'adénome.Mots clés: Prolactinome, péri ménopause, agoniste dopaminergiqueEnglish Title: Prolactin-secreting microadenoma in menopausal womenEnglish AbstractProlactin-secreting adenoma is rare in elderly women. Patient’s clinical picture may be confused with that of menopause, making diagnosis sometimes difficult. We report the case of a 57-year old woman with a 2-year history of secondary amenorrhea without hot flushes associated with galactorrhea in order to highlight the peculiarities of prolactin-secreting microadenomas. Physical examination confirmed the diagnosis of galactorrhoea and biology showed hyperprolactinemia at mIU/L, FSH = 15.1 IU/L and LH = 4,1 IU/L. Pituitary MRI showed left adenoma measuring 8 mm. Patient’s evolution under dopaminergic treatment was marked by the recovery, for a transitional period, of mestrual cycles and the occurrence of hot flushes, normalization of prolactin levels and reduction of adenoma size.Keywords: Prolactinoma, perimenopause, dopaminergic agonis

Benzylthiouracil-Induced Glomerulonephritis

Vasculitis is a rare complication of antithyroid drugs (ATDs). It was first described with Propylthiouracil (PTU). We report a new case of antineutrophil cytoplasmic antibody (ANCA) vasculitis with glomerulonephritis induced by Benzylthiouracile (BTU). A 50-year-old man with Graves disease treated with BTU developed general malaise and haematuria without skin rash or respiratory involvement. Laboratory data revealed acute renal failure with proteinuria and haematuria. An indirect immunofluorescence test for ANCA was positive, showing a perinuclear pattern with specificity antimyeloperoxidase (MPO). A renal biopsy was performed and revealed pauci-immune extracapillary glomerular nephropathy and necrotic vasculitis lesions. Based on these findings we concluded to the diagnosis of rapidly progressive glomerulonephritis associated with ANCA induced by BTU therapy. The drug was therefore discontinued and the patient was treated with steroids and immunosuppressive treatment during 3 months. Renal failure, proteinuria and haematuria significantly improved within 2 months. However, P-ANCA remained positive until 10 months after drug withdrawal. Thyroid function was kept within normal range using iodine solution. We demonstrated clearly that BTU may induce severe forms of vasculitis with glomerulonephritis. Thus, the ANCA must be measured when confronted to systemic manifestation during treatment

Correlation between superficial and intra-operative specimens in diabetic foot infections: results of a cross-sectional Tunisian study

Objective: To determine the correlation between superficial, and intra-operative specimens in diabetic foot infections (DFIs). Methods: We conducted a cross-sectional study in patients with DFIs hospitalized in a Tunisian teaching hospital. Superficial specimens were collected for all patients, and intra-operative specimens were collected in operated patients. The specimens were processed using standard microbiology techniques. Antimicrobial susceptibility testing was carried out according to the protocol established by the European Committee on Anti-microbial Susceptibility Testing. Intra-operative and superficial specimens were considered correlated if they isolated the same microorganism(s), or if they were both negative. Results: One hundred twelve patients, 81 males and 31 females, mean age 56 years, were included. Superficial samples were positive in 77% of cases, and isolated 126 microorganisms. Among the positive samples, 71% were monomicrobial. The most frequently isolated microorganisms were Enterobacteriaceae (53%), followed by streptococci (21%) and Staphylococcus aureus (17%). Nine microorganisms (7%) were multi-drug resistant. Intra-operative samples were positive in 93% of cases. Superficial specimens were correlated to intra-operative specimens in 67% of cases. Initial antibiotic therapy was appropriate in 70% of cases. The lower-extremity amputation and the mortality rates were 41% and 1%, respectively. Conclusion: In our study, DFIs were most frequently caused by Enterobacteriaceae and superficial specimens were correlated to intra-operative specimens in only two thirds of cases. Clinicians should emphasize on the systematic practice of intraoperative specimens in all patients with DFIs treated surgically, while well-performed superficial specimens could be useful for prescribing appropriate antibiotic therapy in other patients

Diabète de type 1 post-traumatique chez un soldat de l’armée

L'influence du stress comme facteur précipitant l'apparition du diabète de type 1 est un sujet largement étudié dans la littérature. La relation entre les traumatismes physiques et psychologiques et le diabète ont été un sujet rarement étudié en milieu militaire. Le diabète post-traumatique reste toujours un sujet controversé. Nous rapportons le cas d'un soldat tunisien, sans antécédents personnels ou familiaux d’auto-immunité, qui a été diagnostiqué pour un diabète de type 1 au décours d’une agression physique lors de conflits sociaux entre les forces de l’ordre et les citoyens

Diagnosis and treatment difficulties of psychiatric symptoms in Klinefelter syndrome: a case report

Klinefelter syndrome (KS) can involve various psychiatric symptoms that are often heterogeneous and atypical. To illustrate the diagnosis and treatment difficulties of psychiatric non-specific symptoms occurring in KS, we report a 17-year-old man presenting with gynaecomastia and marfanoid features. Investigations showed high concentrations of gonadotrophins and a 47,XXY karyotype. Although his serum testosterone was normal, the patient had clinical hypogonadism and suffered from recent headache. Magnetic resonance imaging revealed pituitary non-invasive macroadenoma. Treatment with Cabergolin resulted in a normalisation of prolactin levels and a decrease in tumour size. During follow-up, the patient presented a permanent state of passivity and disinterest in imaginative experiences, without any obvious specific diagnoses, according to psychiatric examination. Further investigations showed major depression, schizotypical personality and patterns of psychotic functioning. Initial treatment with selective serotonin re-uptake inhibitors was not effective and he was switched to an atypical antipsychotic drug that was not tolerated and rapidly stopped by the patient