Spondylarthrite ankylosante et maladie de Still: un lien physiopathologique ou une simple association?

La spondylarthrite ankylosante est un rhumatisme inflammatoire chronique,qui fait partie des groupes de spondyloarthrites, au cours duquel les signes généraux comme la fièvre et l'amaigrissement sont peu importants. La maladie de Still de l'adulte est une affection systémique rare, qui reste un diagnostic d'élimination, et qui associe classiquement une fièvre élevée hectique, une éruption cutanée, des arthrites, et des manifestations systémiques diverses. Peu de cas de spondylarthrites ankylosantes présentés avec un tableau de la maladie de Still de l'adulte ont été décrits dans la littérature. Nous rapportons un nouveau cas d'un patient de 31ans suivi pour spondylarthrite ankylosante et qui se présente avec une fièvre au long cours et des signes clinico-biologiques entrant dans le cadre de la maladie de Still de l'adulte. Un éventuel lien physiopathologique entre les deux pathologies peut être évoqué, même si leur survenue simultanée est rarement rapportée dans la littérature

Hemichorea-hemiballismus as an initial manifestation in a Moroccan patient with acquired immunodeficiency syndrome and toxoplasma infection: a case report and review of the literature

Neurologic signs and symptoms may represent the initial presentation of AIDS in 10-30% of patients. Movement disorders may be the result of direct central nervous system infection by human immunodeficiency virus (HIV) or the result of opportunistic infections. We report the case of a 59 years old woman who had hemichorea-hemiballismus subsequently found to be secondary to a cerebral toxoplasmosis infection revealing HIV infection. Movement disorders, headache and nausea were resolved after two weeks of antitoxoplasmic treatment. Brain MRI control showed a marked resolution of cerebral lesion. Occurrence of hemichorea-ballismus in patient without familial history of movement disorders suggests a diagnosis of AIDS and in particular the diagnosis of secondary cerebral toxoplasmosis. Early recognition is important since it is a treatable entity

Magnetic resonance imaging findings within the posterior and lateral columns of the spinal cord extended from the medulla oblongata to the thoracic spine in a woman with subacute combined degeneration without hematologic disorders: a case report and review of the literature

<p>Abstract</p> <p>Introduction</p> <p>Subacute combined degeneration of the spinal cord is a rare cause of demyelination of the dorsal and lateral columns of the spinal cord and is a neurological complication of vitamin B₁₂deficiency. Subacute combined degeneration without anemia or macrocytosis is rare.</p> <p>Case presentation</p> <p>We present a case of cobalamin deficiency in a 29-year-old Moroccan woman who presented with subacute combined degeneration without evidence of anemia or macrocytosis. Magnetic resonance imaging of the spinal cord demonstrated abnormal hyperintense signal changes on T2-weighted imaging of the posterior and lateral columns from the medulla oblongata to the thoracic spine. A diagnosis of subacute combined degeneration of the spinal cord was considered and confirmed by low serum cobalamin. The patient was treated with vitamin B₁₂supplements and showed improvement in her clinical symptoms.</p> <p>Conclusion</p> <p>Physicians should diagnose subacute combined degeneration in patients early by having a high index of suspicion and using diagnostic tools such as magnetic resonance imaging.</p

Visceral leishmaniasis in 26 HIV-negative adults

<p>Abstract</p> <p>Background</p> <p>Visceral leishmaniasis is a notifiable parasitic disease that had increased in incidence in our region on the past few years. It is common in children. In adults, it occurs more on a background of immunodeficiency, and frequently with incomplete clinical manifestations, making the diagnosis complicated.</p> <p>Findings</p> <p>The aim of our study is to reveal different features of visceral leishmaniasis in adults, through the analysis of its epidemiological, clinical and biological parameters, in a group of 26 patients. No one was infected with HIV or under immunosuppressive therapy Clinical presentation was generally conservative, but there was few differences in adults compared to children, concerning both the clinical symptoms and the laboratory parameters. Diagnosis was provided by direct examination of bone marrow smears in 24 cases (sensitivity 92%), and anti-leishmanial serology in the others.</p> <p>Conclusion</p> <p>We should think to the diagnosis of VL even if the patient is not known immunocompromised, and even if the clinical is incomplete, to avoid a delay of care which can lead to serious complications.</p

Purpura vasculaire, hémorragie alvéolaire : Penser aux effets secondaires du Rituximab

Résumé : Le Rituximab est un anticorps monoclonal anti-CD20 indiqué dans les lymphomes non hodgkiniens, la leucémie lymphoïde chronique et la polyarthrite rhumatoïde réfractaire, mais aussi largement utilisé dans les maladies auto-immunes ; il a changé le pronostic et l’évolution de ces maladies, aux dépens d’effets secondaires, parfois graves. Nous rapportons à travers cette observation, le cas d’une patiente suivie pour un syndrome des anti-synthétases réfractaire, et qui a développé un purpura vasculaire associée à une hémorragie alvéolaire après la perfusion de Rituximab, avec une bonne évolution clinique et radiologique après arrêt du traitement et sous corticothérapie. Summary : Rituximab is an anti-CD20 monoclonal antibody indicated in non-Hodgkin’s lymphoma, chronic lymphocytic leukaemia and refractory rheumatoid arthritis, but also widely used in auto-immunes; it has changed the prognosis and evolution of these diseases, at the expense of side effects, sometimes serious. We report through this observation, the case of a patient followed for a refractory anti-synthetase syndrome and who developed vascular purpura associated with alveolar haemorrhage after infusion of Rituximab, with good clinical and radiological progress after discontinuation of treatment and corticosteroid therapy