A. Rezgui

La maladie de Takayasu dans la région centre de la Tunisie. À propos de 27 cas

BACKGROUND Takayasus arteritis is a rare inflammatory disease and few data are available in Tunisia. The aim of this study is to evaluate clinical and radiological features of the disease in the centre of Tunisia. METHODS We retrospectively studied medical records of patients treated in departments of internal medicine or cardiology from three university hospitals in Sousse and Monastir over the period 1985-2005. The criteria for inclusion were those proposed by the American College of Rheumatology. RESULTS Twenty-seven patients were identified. The mean age at presentation was 33.2 years (range 16-68 years) and 88.9% were female. The mean delay from the onset of the symptoms to the time of diagnosis was 4.2 years. Intermittent claudication was the most common presentation (81.5%) and hypertension was noted in 40.7% of cases. Arterial localization most frequently involved was subclavian artery. The aorta was involved in 52.3% and renal arteries in 36.3% of cases. Stenosis or occlusions was constant but aneurysms were noted in 7.4%. Functional difficulty was the main complaint in the follow-up, death related to Takayasus disease was noted in 3.7%. The mean follow-up time was 75.8 months (6.3 years). CONCLUSION There is no epidemiologic particularity of Takayasus disease in Tunisia, however involvement of the subclavian artery was more frequent than the aortic localization.

Cellulitis in aged persons: a neglected infection in the literature

Cellulitis is a frequent soft tissue and skin infection. The lower limbs are affected in 70 to 80% of cases. Cellulitis in aged persons is not yet well described in literature. A retrospective descriptive study conducted in the Internal Medicine Department of Sahloul hospital in Sousse in Tunisia. It included patients whose age was up to 65 years old admitted into hospital for cellulitis of the legs, the arms or the face. One hundred fifty eight patients with a mean age of 73 years old (range: 65 to 94 years old) were included. Female to male sex ratio was 0.68. Among them, we noted diabetes mellitus in 81 cases (50.6%). The infection was located in the lower limbs in 155 cases (98%), in the face in two cases (1.3%) and in the upper limb in one case (0.7%). Twenty one patients (13.3%) presented with severe cellulitis and one presented with necrotizing fasciitis. All patients received intra venous antibiotic therapy. Surgical treatment was indicated in 14 cases. Cefazolin was prescribed in 77 cases (48%). Favorable evolution was noted in 144 patients (91.1%). Forty four patients (27.8%) received prophylactic antibiotics. Prevention of skin and soft tissue infection is a crucial step to preserve health in aged persons.

Takayasu's disease in the center of Tunisia: 27 cases.

BACKGROUND Takayasus arteritis is a rare inflammatory disease and few data are available in Tunisia. The aim of this study is to evaluate clinical and radiological features of the disease in the centre of Tunisia. METHODS We retrospectively studied medical records of patients treated in departments of internal medicine or cardiology from three university hospitals in Sousse and Monastir over the period 1985-2005. The criteria for inclusion were those proposed by the American College of Rheumatology. RESULTS Twenty-seven patients were identified. The mean age at presentation was 33.2 years (range 16-68 years) and 88.9% were female. The mean delay from the onset of the symptoms to the time of diagnosis was 4.2 years. Intermittent claudication was the most common presentation (81.5%) and hypertension was noted in 40.7% of cases. Arterial localization most frequently involved was subclavian artery. The aorta was involved in 52.3% and renal arteries in 36.3% of cases. Stenosis or occlusions was constant but aneurysms were noted in 7.4%. Functional difficulty was the main complaint in the follow-up, death related to Takayasus disease was noted in 3.7%. The mean follow-up time was 75.8 months (6.3 years). CONCLUSION There is no epidemiologic particularity of Takayasus disease in Tunisia, however involvement of the subclavian artery was more frequent than the aortic localization.

Artériosclérose diffuse inexpliquée chez une jeune patiente de 26 ans

Arteriosclerosis is an alteration of the blood vessels whose walls calcify, lose their elasticity and thicken. The result is a decrease in circulating blood flow and ischemic manifestations. Calcification of the arteries is a physiological phenomenon in the elderly but young subjects may also be affected. Indeed, certain risk factors can favor the formation of plaques at the level of the vessels. These include classic cardiovascular risk factors, as well as systemic inflammatory diseases, connective tissue diseases, chronic hypercalcemia… We report the case of a 26-year-old female patient with diffuse arteriosclerosis discovered accidentally, and whose exhaustive etiological investigation remained negative.

Amyloïdosis, sarcoidosis and systemic lupus erythematosus

The occurrence of renal and multiple organ Amyloïdosis is currently considered exceptional in the course of systemic lupus erythematosus. We report a case of a concomitant SLE and Amyloïdosis in a 57 year old female patient with hypothyroidism history, who presented with erythema nodosum, fever, arthralgia and sicca syndrome. Biological findings showed an inflammatory syndrome, renal failure, proteinuria (1g / 24h), positive auto antibodies and anti DNA. Lung radiology revealed medistinal lymphadenopathy, pleural nodules, ground glass infiltrates and pleuritis. Bronchial biopsy showed non specific inflammation. The salivary gland biopsy showed amyloïd deposits. This case report reminds us that lupus and Amyloïdosis association, although exceptional remains possible. The occurrence of Lofgren syndrome in this situation make the originality of this report.

Tuberculose multifocale chez les immunocompétents

Multifocal tuberculosis is defined as the presence of lesions affecting at least two extrapulmonary sites, with or without pulmonary involvement. This retrospective study of 10 cases aims to investigate the clinical and evolutionary characteristics of multifocal tuberculosis. It included 41 cases with tuberculosis collected between 1999 and 2013. Ten patients had multifocal tuberculosis (24%): 9 women and 1 man, the average age was 50 years (30-68 years). Our patients were correctly BCG vaccinated. The evaluation of immunodepression was negative in all patients. 7 cases had lymph node tuberculosis, 3 cases digestive tuberculosis, 2 cases pericardial tuberculosis, 2 cases osteoarticular tuberculosis, 1 case brain tuberculosis, 2 cases urinary tuberculosis, 4 cases urogenital tuberculosis, 1 case adrenal tuberculosis, 1 case cutaneous and 1 case muscle tuberculosis. All patients received anti-tuberculosis treatment for a mean duration of 10 months, with good evolution. Multifocal tuberculosis is difficult to diagnose. It can affect immunocompetent patients but often has good prognosis. Anti-tuberculosis therapy must be initiated as soon as possible to avoid sequelae.

Acidose lactique à la metformine : une complication rare

ratio 0,84 ; p < 0,05). La durée du diabète (5,1 ans [2,6–8,0]), la dose d’insuline (0,94 U/kg [0,78–1,11]), le schéma de traitement (pompe 41,5 %, multiinjections 42,3 %, autres 16,2 %), l’HbA1c (8,1 % [7,4–8,9]) et le z score de IMC (0,73 ± 1,07) étaient similaires dans les 2 groupes. Les adolescents ainsi que leurs parents étaient très satisfaits de la pratique de l’IF. Discussion.– Cet état des lieux pourrait servir de base à l’élaboration d’un programme standardisé de formation à l’IF, chez l’enfant et l’adolescent ayant un DT1.

Hypothyroïdies : aspects épidémiologiques, cliniques et paracliniques dans un service de médecine interne

Observation.– Patiente de 66 ans, depuis 5 ans, tuméfaction latérocervicale droite. Augmentation récente du volume avec apparition d’un flush syndrome et diarrhées motrices. L’examen clinique a objectivé un goitre mulinodulaire avec un volumineux nodule médiolobaire droit de 3 cm, durs et fixes, avec une adénopathie sus claviculaires droite. L’échographie et la TDM cervicale ont montré un goitre, siège de multiples formations nodulaires hypoéchogènes, les plus gros nodules siègent au niveau médiolobaire droit de 3 cm, multiples adénopathies cervicales jugulo-carotidiennes bilatérales. La TSH normal, alors que le taux de calcitonine était très élevé à 70 059 ng/dL, l’ACE était élevé à 231,4 g/L. La scintigraphie osseuse a mis en évidence des métastases osseuses multiples. La prise en charge a consisté en une thyroïdectomie totale avec curage extensif après avoir éliminé un phéochromocytome. L’étude anatomopathologique a objectivé un carcinome médullaire, multifocal avec effraction capsulaire, associé à des métastases ganglionnaires. En postopératoire, on note la persistance du flush syndrome, qui suggère que la maladie est toujours évolutive. Discussion.– À la lumière de cette observation, le taux de calcitonine semble un facteur de mauvais pronostic puisqu’il suggère que le carcinome est au stade métastatique, comme l’atteste le cas de cette patiente dont le CMT a été révélé au stade de métastases ganglionnaires multiples.

Diabète de type 2 du sujet âgé et comorbidité, à propos de 300 cas

Objectifs.– Le but de ce travail est de préciser les caractéristiques cliniques et thérapeutiques des infections associées au diabète. Patients et méthodes.– Étude rétrospective portant sur 28 diabétiques hospitalisés à l’institut de nutrition de Tunis pour déséquilibre glycémique suite à une infection. Résultats.– L’âge moyen était de 68 ans avec un sex-ratio de 0,4. L’âge moyen du diabète était de 10,71 ans. Il s’agit d’un diabète de type 1 dans 18 % des cas et de type 2 dans 82 % des cas. L’infection était cutanée dans 42,85 % des cas dont la moitié était un pied diabétique ; urinaire 40,7 % ; dentaire 3,7 % ; génitale, otorhinolaryngologique et pulmonaire 3,5 % chacun. La majorité des patients était en bon état général (79 % des cas) mais fébriles dans 10 % des cas, la vitesse de sédimentation était accélérée dans 43 % des cas avec une hyperleucocytose dans 32 % des cas. Une antibiothérapie était instaurée dans 71 % des cas, il s’agit de pénicilline 43 %, de fluoroquinolones 28 %, de flagyl 15 % et de fucidine 14 %. La majorité des patients était améliorée cliniquement et biologiquement avec une vitesse de sédimentation de contrôle moyenne de 7,5 mm à la deuxième heure et une protéine C réactive moyenne de 3,76 mg/L. Discussion.– Le diabète favorise les infections bactériennes et mycosiques surtout urinaires et cutanées. Les infections sont source de déséquilibre du diabète. Ainsi, devant la perturbation d’un diabète habituellement bien équilibré, il faut rechercher une infection et la traiter rapidement.

Non-Secretory Multiple Myeloma with Lytic Bone Lesions about a New Observation

Non-excretory myeloma is a rare variety of multiple myeloma in which classical techniques of research of the stigmata of chronic secretion fail to highlight the monoclonal peak or proteinuria of Bence Jones. Lytic bone lesions are rare in this type of myeloma. We report the case of a patient in whom we confirmed multiple myeloma by bone marrow aspiration and we have classified stage III of Durie and Salmon in view of hypercalcemia, anemia, and lytic lesions observed. However, we could not isolate a secretion of monoclonal immunoglobulin in blood but urinary secretion was evident by proteinuria and urinary light chains. The radiographs of our patient were highly suggestive of osteolysis seen diffuse the practice of sternal puncture has emerged even in the absence of criteria such as blood secretion highlighting the monoclonal peak in serum protein electrophoresis or the quantitation of immunoglobulins. Our case original seen that the diffuse osteolytic lesions were often observed within the secretory disease and rarely in the form of non-secreting.