A. Le Quellec

L'oxyntomoduline, nouveau marqueur hormonal des syndromes de malabsorption intestinale

Plasma oxyntomodulin-like immunoreactivity (OLI) concentrations were found to be significantly elevated in 6 patients with cœliac disease when compared with those observed in 38 healthy subjects. Furthermore, OLI hypersecretion is related to the degree of malabsorption. This marker could be used as a test for detection and follow-up of patients with malabsorptive disorders.

Asymptomatic bilateral pulmonary embolism in Churg–Strauss syndrome

To the Editor: Churg–Strauss syndrome (CSS) is a systemic small-sized vessel vasculitis, characterised by severe asthma, transient pulmonary infiltrates, and blood and tissue eosinophilia [1]. CSS can affect several organs, including the lungs, heart, kidneys and peripheral nervous system. Anti-neutrophil cytoplasm autoantibodies (ANCA) mainly directed against myeloperoxidase (MPO) are detected in ∼40% of patients and are associated with renal involvement. Several studies have focused on venous thromboembolic events (VTE), which are an emerging clinical condition in ANCA-associated vasculitides (AAV) [2, 3]. Herein, we report the case of a patient with newly diagnosed CSS and totally asymptomatic pulmonary embolism, and discuss the features, pathogenesis and management of VTE in CSS. In February 2011, a 61-yr-old male was referred for recent asthenia, diffuse arthromyalgia and blood eosinophilia. His past medical history included high blood pressure treated with amlodipine. There were no other risk factors for VTE other than age and inflammatory state. His recent history included late-onset asthma, which started 1 yr earlier and required various combined inhaled corticosteroids, bronchodilators and several short courses of oral corticosteroids. In early December 2010, the patient complained of general weakness, weight loss and diffuse myalgia. In late December, another asthma flare-up was successfully treated with a course of oral prednisolone (1 mg·kg−1 per day for 5 days), which was effective for both myalgia and weakness. Unfortunately, muscle and joint pain immediately relapsed as soon as corticosteroids were discontinued, while respiratory symptoms had improved. In February 2011, a thoracic computed tomography (CT) scan was performed, focusing on the parenchyma not vessels. No lesions were reported. At the same time, distal paresthesia appeared and subsequently concerned the lower left and upper right limbs. Following this, the patient was referred to our department (Internal Medicine …

Leucoencéphalite hémorragique aiguë secondaire à une réactivation du virus d’Epstein-Barr

e contraste, associés à des hyposignaux punctiformes multiples en séquence 2*, évoquant une cérébellite hémorragique. Un bilan complémentaire exhaustif carte une pathologie lymphomateuse, une localisation cérébrale de la vasculaite ou une autre étiologie infectieuse. Le diagnostic d’encéphalite secondaire à ne réactivation d’EBV est retenu et un traitement par aciclovir et corticoïdes ntraveineuses est débuté pour une durée de 21 jours. Une amélioration clinique pectaculaire est observée dès j3 et se complète en 1 mois. Devant l’évolution avorable, il n’est pas proposé de biopsie cérébrale. Après 6 mois de suivi, la orticothérapie est réduite à 0,3 mg/kg par jour sans signe d’échappement de la ériartérite noueuse. bservation.– Les manifestations neurologiques liées à EBV sont classiqueent l’apanage de la primo-infection, cependant, il existe plusieurs cas dans la ittérature illustrant des troubles neurologiques chez l’adulte immunocompétent u décours d’une réactivation virale. La présence d’hyposignaux T2* en IRM igne le caractère hémorragique de la leucoencéphalite, déjà décrit au cours ’autopsies dans ces situations. Il n’existe pas de traitement antiviral spécifique t l’adjonction d’une corticothérapie reste débattue. onclusion.– Une encéphalite liée à EBV est possible chez l’adulte, même en ’absence de lymphome. L’IRM cérébrale peut mettre en évidence, au sein des ésions inflammatoires, une transformation hémorragique évocatrice du diagostic et doit être renouvelée en cas de négativité initiale. our en savoir plus Tselis A, Duman R, Storch GA, Lisak RP. Epstein-Barr irus encephalomyelitis diagnosed by polymerase chain reaction: detection of he genome in the CSF. Neurology 1997;48:1351–5. ranscisci D, Sensini A, Fratini D, Moretti MV, et al. Acute fatal necrotizing emorrhagic encephalitis caused by Epstein-Barr virus in a young adult immuocompetent man. J Neurovirol 2004;10:414–7. ujimoto H, Asaoka K, Imaizumi T, Ayabe M, Shoji H, Kaji M. Epstein-Barr irus infections of the central nervous system. Intern Med 2003;42:33–40.

Tumeur sciatique plasmocytaire de la maladie de Kahler: imagerie inédite

We report the case of a 58-year-old man in whom a sciatic nerve plasma cell infiltration developed in the course of a relapsing IgG myeloma. The mass of the right thigh was palpable, measuring 11×7 cm. We underline the extreme rarity of this localization of an extramedullary plasmocytoma, and the usefulness of magnetic resonance imaging in establishing the diagnosis.

Livedo réticulaire révélant une fièvre Q: responsabilité d'un anticoagulant circulant

We report the case of a 47 year-old-man which was referred for fever and livedo reticularis related to a circulating anticoagulant. Serologic tests for Coxiella burnetii were strongly positive. Tetracycline allowed resolution of fever and cutaneous signs, while coagulation tests normalized. Q-fever must be added to the list of infectious diseases likely to be associated with a circulating anticoagulant.

Abcès métastatiques gingivaux et sous-cutané: dissémination inattendue de la tuberculose

The authors report a case of metastatic tuberculous abscesses, unusual by their gingival and cutaneous localizations. These abscesses result from hematogenous spread from a primary focus during periods of bacillemia and lowered resistance. Differential diagnosis includes syphilitic, sporotrichosis and actinomycosis gummata.

Rechute réfractaire d'une maladie de Wegener: penser à l'aspergillose !

A 45-year-old woman treated with low-dose glucocorticoids and cyclophosphamide for Wegener granulomatosis was referred for fever, cough and infiltrate of the right lung. Percutaneous lung aspiration yielded Aspergillus fumigatus whereas bronchoscopy was nondiagnostic. Antifungal chemotherapy led to a dramatic improvement. We underline the difficulty to distinguish this opportunist infection from active vasculitis.

Diffusion systémique du bacille de Calmette-Guérin après instillation intra-vésicale

We report a case of jaundice, fever, weight loss and pancytopenia occurring in a 61-year-old man after transurethral administration of bacillus Calmette-Guerin. Liver and bone marrow biopsies both found disseminated granulomas but no organisms were identified in these tissues. The patient was successfully treated with isoniazid and rifampicin for 8 months.

Modifications des sous-populations lymphocytaires circulantes induites par la méthylprednisolone intra-veineuse à dose massive

Abstract Lymphocyte subpopulations from 4 subjects with different immunological diseases were studied by flow cytometry before and after high dose intravenous methylprednisolone. The long-recognized lymphopenia was confirmed for CD4(+) cells, but also affected CD 19(+) cells at the same degree. We found a paradoxical increase for activated T-cells and CD16(+) cells. Return to prepulse level was always complete by 24 hours.

Endocardite aiguë fatale à Chlamydia psittaci

Abstract Endocarditis occurring in the course of a psittacosis is a rare but serious event. We describe the case of a 79-year-old woman dead in 50 days because of intractable cardiac failure in spite of a precocious and appropriate antibiotic therapy.