Sarcoidosis with heart involvement: a rare association of terrible prognosis, a report of two cases

Sarcoidosis is a multisystemic disorder of unknown etiology which is characterized by the formation of  non-caseating granulomas in involved tissues. Cardiac involvement is one of the least common manifestations and it can occur at any point of time during the course of sarcoidosis. Here we present the case of 2 patients with known sarcoidosis who develop cardiac abnormalities in the absence of known primary cardiac cause. In our report, we would like to draw attention to the importance of considering heart involvement in any case with systemic sarcoidosis especially in young age.Key words: Cardiac sarcoidosis, Sarcoidosis, Ventricular arrhythmia

Un anévrysme sacciforme de l’aorte abdominale révélant une maladie de Behçet: quand faut-il opérer?

L'atteinte vasculaire est fréquente au cours de la maladie de Behçet. Elle est essentiellement représentée par les thromboses veineuses alors que l'atteinte artérielle est plus rare. Elle peut être isolée ou multifocale et peut toucher tous les territoires avec prédilection pour l’aorte abdominale, les artères pulmonaires et les artères des membres inférieurs. L'atteinte anévrysmale de l'aorte abdominale est trompeuse se manifestant par une symptomatologie atypique responsable d'un retard diagnostique favorisant la rupture. Dans notre cas, des douleurs abdominales paroxystiques ont incité le patient à consulter rapidement. L’enquête étiologique a conclue à un angio Behcet. Rarement, l’anévrysme de l’aorte abdominale est révélé par une complication telle que la rupture dans le rétro péritoine ou le tube digestif. Les indications chirurgicales des anévrysmes de l’aorte sont discutées ici. Un traitement immunosuppresseur au long cours s’impose en post opératoire pour limiter le risque de récidive

Dermatomyosite et panniculite: place des immunoglobulines

La panniculite est une maladie inflammatoire du tissu adipeux sous-cutané rarement associée à la dermatomyosite. Elle peut survenir avant, après ou en même temps que l'atteinte musculaire. Dans la plupart des cas, l'évolution de la panniculite et des autres atteintes de la dermatomyosite est favorable sous traitement corticoïde et/ou immunosuppresseur. Nous rapportons le cas d'une patiente âgée de 48 ans ayant présenté des lésions de panniculite précédant de 2 mois les signes musculaires. L'atteinte cutanée était résistante au traitement corticoïde associés aux immunosuppresseurs ce qui a nécessité le recours au traitement par Immunoglobulines polyvalentes permettant ainsi une amélioration à la fois de l'atteinte cutanée et musculaire.Pan African Medical Journal 2016; 2

0391: Cardiac involvement in ankylosing spondylitis

BackgroundCardiac involvement in ankylosing spondylitis is common. We have tried through this study to analyze the cardiovascular events among 50 patients with ankylosing spondylitis.MethodsA retrospective study including 50 patients with ankylosing spondylitis. All patients underwent a complete physical examination with a heart and lung auscultation and an electro-cardiogram (ECG). Transthoracic ultrasound was performed whenever there was an abnormal physical examination and/or ECG.ResultsThe study included 47 men and 3 women, the sex ratio is 15,6. The average age of onset was 26±7 years. The mode of onset is axial in 95% of cases (low back pain and/or buttock). The extra-articular manifestations are present in 54% of cases. Cardiac involvement is present in 9 cases (18% of cases). The reason for consultation is dyspnea in 2 patients. In other cases, cardiac involvement was discovered incidentally. Aortic regurgitation was noted in 4 patients. Mitral insufficiency was found in 3 cases. Two patients have predominantly septal hypertrophic cardiomyopathy and one patient presented an array of pulmonary insufficiency. The average time of onset of cardiac involvement was 8±5 years. All patients were put under special medical treatment of their heart, with good clinical outcome.ConclusionCardiac involvement in ankylosing spondyllitis is seen more frequently in men, especially in the old cases. A close relationship between time to onset of aortic insufficiency and duration of disease progression was found. It would be responsible for one third of deaths of patients. It was significantly more frequent in HLA B27 positive patients (especially complete atrioventricular block and aortic insufficiency)

Tuberculose claviculaire révélée par une lacune osseuse

Our study reports the case of a 30 years old woman, Mrs. S.S, with no particular past medical history. The anamnesis revealed an occasional consumption of not pasteurized dairy products. She was examined after the fortuitous discovery of a swelling in her right clavicular region, with no associated general symptoms. Physical exam revealed a mass measuring 4 cm (long axis) of hard consistency, painless, without inflammatory signs and fixed to deep plane. The remaining elements in somatic examination were normal. Biology was without abnormalities. Tuberculin intradermal reaction (IDR) was phlyctenular. Standard radiographic evaluation of the shoulder showed a bone gap of the distal edge of the right clavicle. MRI revealed anterior-superior cortical-medullary osteolysis of the right clavicle with irregular aspect, erosion and thinning of the adjacent cortical bone sparing the acromioclavicular joint and predominantly anterior inflammation of periosseous soft tissues (Figure A). Bone biopsy showed multiple follicular lesions composed of epithelioid cells and giant cells surrounding wide ranges of caseous necrosis. The thoraco-abdominopelvic CT and bone scintigraphy showed no other alterations. The diagnosis of isolated clavicular tuberculosis was retained. The patient underwent quadruple antituberculosis treatment (isoniazid, rifampicin, ethambutol and pyrazinamide) for two months and then a combination therapy (isoniazid and rifampicin) for a total treatment duration of 9 months. Clinical and radiological outcome was favorable. The patient underwent 18-month follow-up.Pan African Medical Journal 2016; 2

The Cointegration Relationship between Patent, Domestic Investment and Economic Growth in United States of America

This empirical paper searched the three way-linkage between patent, domestic investment, and economic growth in the case of USA during the period 1980 – 2020. By using cointegration analysis and VECM Model, we found that there is no causal relationship between the three variables in the long run. However, we found that domestic investment and economic growth cause patent in the short run. which explains why patents are not a source of economic growth and domestic investment in America and that there are other determinants that have stimulated American economic activity

Severe metastatic calcifications in a hemodialysis patient

Tissue calcification is a common complication in patients on continuous hemodialysis (HD) for chronic renal failure; however, severe calcification is unusual. Three distinct clinical types of extraosseous calcifications are found in uremic patients: vascular calcification, periarticular (tumoral) calcification, and visceral calcification (heart, lung, and kidney). We report a case of a young chronic HD patient who presented with extensive metastatic calcifi cations both vascular, visceral specially localized in the lungs, and periarticular with progressively increasing multiple subcutaneous swellings. This evolution was secondary to noncompliance of the patient to the treatment of a malignant hyperparathyroidism with a marked elevation of phosphocalcium product

Renovascular hypertension: A report of 21 cases

Renovascular hypertension (RVH) is among the most common forms of secondary hypertension. We studied 21 patients (eight male and 13 female) with RVH who were encountered during a period of 16 years. The average age of the patients was 34.75 years. Trans-renal Doppler ultrasound confirmed the diagnosis of renovascular stenosis (RAS) as the cause of RVH in 95% of the patients. Computed tomography angiography was performed in ten cases, which confirmed the diagnosis in all these cases. Magnetic resonance angiography was performed in only three patients. Renal scintigraphy was performed in 11 patients, with DTPA in nine patients and with MAG3 in two cases. Arteriography was performed in 15 cases for therapeutic end points. In two patients, we treated the arteries of both kidneys and in 19 cases we treated only one kidney artery. Percutaneous transluminal angioplasty was performed in ten cases. Renal arterial stent placement was performed in three cases in which RAS was from an atherosclerosis etiology. Surgical revascularization was performed in four cases. Nephrectomy was necessary in four cases. After interventional treatment, medical treatment using antihypertensive drugs was necessary in 17 of the patients. After treatment, three patients returned to normal kidney function, while worsening of glomerular filtration rate was noted in four patients. Some complications such as a kidney infarct after treatment, a nephrectomy, artery thrombosis, an ischemic stroke and recurrent RAS were also noted

WERNER SYNDROME: A NEW CASE REPORT

“Werner’s syndrome” or premature aging syndrome is a rare autosomal recessive genetic disease. It is responsible of several complications related to age, including atherosclerosis and association with cancer. We report the case of a 36 year-old-patient, admitted to department of Internal Medicine of the military hospital of Tunis for suspicion of systemic sclerosis. The patient had all the major signs of Werner syndrome (bilateral cataract, sclerotic skin, “bird face”, baldness, small size, parental consanguinity) and 4 minor signs (type 2 diabetes, hypogonadism, squeaky voice, and flat feet). She has also a brother with the same morphotype died at the age of 32 by a myocardial infarction. The current follow-up time is 9 years.

DIGITAL ISCHEMIA DUE TO SYSTEMIC SCLEROSIS ASSOCIATED WITH ESSENTIAL THROMBOCYTHEMIA: A CASE REPORT

Digital ulcers (DU) are a well-known problem in patients with systemic sclerosis. It is an underestimated complication of the disease causing pain and morbidity. Essential thrombocytosis is another cause of DU. The association of theses two diseases increases the risk of ischemic complications and impairment of hand function which are frequently observed in patients with digital ulcers. This report deals with a 68-year-old patient with rare association of Essential thrombocytosis ,Systemic sclerosis and Raynaud’s phenomenon that was refractory to medical treatment of Systemic sclerosis (illoprost,calcium channel blockers) and improved with hydreaR