Bifocal Tuberculosis with Adalimumab Revealed by Laryngeal Involvement: Case Report

Introduction. Anti-TNF treatment has transformed the treatment of chronic inflammatory rheumatism. Although the therapy can be highly effective, anti-TNF drugs are associated with an increased risk of tuberculosis, especially extra-pulmonary tuberculosis. Laryngeal tuberculosis is rare and its symptoms are not specific. Laryngeal tuberculosis is often secondary to another localization, particularly pulmonary. In the use of anti-TNF therapy, its development is unusual. Case report. We report a case of bifocal tuberculosis: laryngeal and pulmonary tuberculosis revealed by laryngeal involvement in a patient aged 41 years with axial spondylarthritis treated with Adalimumab. Conclusion. This presentation highlights the importance to consider the rare possibility of laryngeal tuberculosis in the presence of atypical otorhinolaryngologic signs under anti-TNF therapy and underlines the importance of looking for other tuberculosis involvement

LE lymphangiome kystique de l’abdomen chez l’adulte.

Le lymphangiome kystique est une tumeur malformative bénigne du système lymphatique, touchant le plus souvent la région crânio-faciale, cervicale ou thoracique. La localisation abdominale est très rare et représente moins de5% chez l’adulte. Rappeler les aspects éthiopathogéniques et diagnostiques et la place de la chirurgie dans le traitement des lymphangiomes kystiques abdominaux de l’adulte et préciser les caractéristiques de certaines localisations. Notre travail porte sur l’étude rétrospective d’une série de sept cas de lymphangiomes kystiques abdominaux de l’adultes traités entre 2002 et 2013 dans le service de chirurgie viscérale 1 de l’hôpital militaire d’instruction Mohammed V- Rabat. L’âge moyen était de trente huit ans avec une prédominance féminine. Les signes cliniques étaient dominés par les douleurs abdominales dans six cas, une masse abdominale palpable dans trois cas, une occlusion intestinale dans un cas, des œdèmes des membres inférieurs dans un cas et une découverte fortuite dans un cas. Les lésions siégeaient essentiellement dans le mésentère (trois cas), le rétropéritoine (deux cas), la rate (un cas) et la surrénale (un cas). La résection tumorale était complète chez tous les malades, au prix d’une résection intestinale segmentaire dans un cas, d’une splénectomie dans un cas et d’une surrénalectomie dans un cas. Après un suivi moyen de six ans, une patiente a présenté une récidive rétropéritonéale. Le lymphangiome kystique de l’abdomen se traduit chez l’adulte par des aspects cliniques et radiologiques très variables faisant l’objet de nombreuses incertitudes diagnostiques. La résection chirurgicale complète, traitement de choix, ne permet pas toujours de prévenir une récidive locale

Monoarthritis of the Elbow Revealing Osteoid Osteoma: A Case Report and Literature Review

Osteoid osteoma is a rare benign osteoblastic tumor that mainly occurs in the extra-articular segments of lower limb long bones. The elbow is an exceptional location for osteoid osteoma. The diagnosis is usually delayed since the elbow is a rare site for this tumor and unspecific clinical signs, such monoarthritis, may mimic other more common conditions. We report the case of a 16-year-old girl who presented with chronic monoarthritis of the elbow which was treated falsely as tuberculous arthritis and monoarticular rheumatoid involvement. The laboratory tests were negative. Computed tomography scan and magnetic resonance imaging showed the focal nidus at the coronoid process of the ulna with mild synovitis. The diagnosis of osteoid osteoma was not made until the disease had been progressing for eighteen months and the elbow had already become stiff. Arthroscopic excision of the lesion was performed, and histopathology of the nidus was consistent with osteoid osteoma. Since then, the patient has been pain-free with an improved elbow range of motion

Achilles Tendon Xanthoma and Cholestanol Revealing Cerebrotendinous Xanthomatosis: A New Case Report

Cerebrotendinous xanthomatosis (CTX) is an autosomal recessive lipid storage disease rarely reported in Africa. Therefore, we report a Moroccan first case report of CTX. A 20-year-old woman was presented in our department for bilateral swelling of the posterior aspect of ankles and the anterior aspect knees with gait disturbances evolving since the age of 7. The patient was the first child of consanguineous marriage. She had bilateral cataracts and developmental delay. Laboratory findings revealed that the plasma cholestanol level was remarkably elevated, and plasma and urine bile alcohol levels were elevated. MRI of ankles showed a bilateral diffuse thickening of the Achilles tendon with hypointense in T1 and heterogeneous hypersignal in T2 with spots in hypersignal in T1 and T2. Brain MRI revealed bilateral and symmetrical T2 hypersignal of dentate nuclei, without white matter signal alterations or cerebral or cerebellar atrophy. A biopsy obtained of the Achilles swelling with a histological study showed an aspect of tendon xanthoma. Hence, the diagnosis of CTX was made. MRI, especially brain MRI, plays an important role in the diagnosis of CTX