D. Ghafir

Lung findings on thoracic high-resolution computed tomography in patients with ankylosing spondylitis. Correlations with disease duration, clinical findings and pulmonary function testing

The aim of this study was to identify the spectrum of abnormalities revealed on high-resolution computerized tomography (HRCT) in patients with ankylosing spondylitis (AS), to compare findings with those of plain radiography and pulmonary function testing (PFT), and to look for correlations between lung involvement and AS severity. We prospectively studied 55 consecutive patients with a diagnosis of AS according to the modified New York criteria who attended our department over a period of 2 years. All patients had a detailed rheumatological examination and underwent plain chest radiography, chest HRCT and PFT. HRCT revealed abnormalities in 29 patients (52.7%), whereas plain chest radiography was abnormal in only 2. Abnormalities consisted of interstitial lung disease (ILD) (n=4), apical fibrosis (n=5), emphysema (n=5), bronchiectasis (n=4), ground glass attenuation (n=2), and non-specific interstitial abnormalities (n=26). Only apical fibrosis and bronchiectasis were statistically more frequent with increasing disease duration (significant trend χ2test, p=0.0029 and 0.028, respectively). PFT showed a restrictive process in 19 patients (34.5%). No correlation was noted between HRCT and PFT, nor with AS symptomatic and structural severity parameters. However, there was a statistically significant correlation between PFT and AS symptomatic and structural severity parameters. In conclusion,: this study confirms that the chest HRCT of patients with AS showed a great number of abnormalities undetectable by standard X-rays. The high incidence of lung abnormalities emphasizes the importance of excluding such a diagnosis in patients with AS even without respiratory symptoms.

A Controlled Study of Sacroiliitis in Behcet's Disease

Abstract: The aim of the study was to evaluate the prevalence of sacroiliitis in a group of patients with Behçet’s disease (BD). Pelvic X-rays of 27 patients with BD responding to the International Study Group of BD and 30 controls (15 AS and 15 sciatica) were read blind and sacroiliac involvement was graded according to the New York criteria. In a second step, patients or controls with equivocal sacroiliitis had a sacroiliac CT scan. Two patients with BD (7.4%) and all patients with AS had evident bilateral sacroiliitis (at least grade 2). One patient with BD and two patients with sciatica had equivocal sacroiliitis (grade 1). CT confirmed sacroiliitis in the two patients with BD and eliminated inflammatory sacroiliitis in the three other patients with equivocal sacroiliitis showing mild degenerative lesions. A review of the literature showed that sacroiliitis and AS are rarely associated with BD. There remains insufficient evidence to suggest that sacroiliitis is an intrinsic feature of BD and that BD belongs to the group of SpA.

Thoracic high resolution computed tomography in patients with ankylosing spondylitis and without respiratory symptoms.

The incidence of pleuropulmonary disease in ankylosing spondylitis (AS) varies from 0 to 30% in the medical literature.1–4 The most frequently recognised manifestations are upper lobe fibrosis, mycetoma formation, and pleural thickening. The advent of high resolution computed tomography (HRCT) made it possible to examine the entire lung parenchyma and pleura in many conditions with diffuse lung disease by a non-invasive method. Consecutive patients with a diagnosis of AS according to the modified New York criteria5 who attend our department during one year were included in the study. All patients had a prospective rheumatological assessment conducted by two rheumatologists (AEM and AB) using a structured questionnaire, a pulmonary function testing measurement, posteroanterior chest radiography; on the same day an HRCT of the thorax was performed using …

Idiopathic retroperitoneal fibrosis and ankylosing spondylitis. A new case report

The case of a 52-year-old man with retroperitoneal fibrosis and ankylosing spondylitis is described. Inflammatory low back pain and acute renal insufficiency prompted a computed tomography scan of the abdomen with contrast agent injection. A fibrous sheath surrounding the aorta and attracting the ureters toward the midline was seen, strongly suggesting retroperitoneal fibrosis. The diagnosis of ankylosing spondylitis was based on the presence of inflammatory low back pain responsive to nonsteroidal anti-inflammatory drugs, syndesmophytes at the lumbar and cervical spine, bilateral sacroiliitis, and presence of the HLA-B27 antigen. Prednisone therapy in a daily dosage of 1 mg/kg induced a marked improvement. Only nine cases of concomitant retroperitoneal fibrosis and ankylosing spondylitis have been reported. These two conditions share similarities in some of the etiologic factors and anatomic localizations, suggesting that both may stem from a predisposition to fibrotic diseases.

Les antagonistes de l’interleukine-6 (tocilizumab) dans la maladie de still réfractaire de l’adulte

INTRODUCTION The pathogenesis of Stills disease is best elucidated for the better recognition of the involvement of Many pro-inflammatory cytokines in the genesis of this condition. Publications have reported the contribution beneficial for certain biotherapeutics, such as anti-TNFa, the anti-CD20 or antagonists of interleukine1 (IL-1) tested successfully in the treatment of systemic Juvenile idiopathic arthritis (Stills disease the child), the tocilizumab is a humanized monoclonal antibody directed against the receptor for interleukin-6 and is beginning to be reported as effective in some refractory cases of Stills disease in adults. PATIENTS We report two young patients with Stills disease in adults with refractory early and prolonged remission after the first infusion tocilizumab. CONCLUSION The tocilizumab can be used in patients MSA with refractory after failure or intolerance conventional treatments.

A rare pediatric case of cutaneous gamma/delta T-cell lymphoma

Cutaneous γ/δ T-cell lymphoma (CGD-TCL) is a recent entity described in the newly revised World health organization-European organization for research and treatment of cancer classification of cutaneous lymphomas. Only a few cases have been reported, of which two pediatric cases. A 15 years old child with a 6 months history of polyadenopathy, cutaneous lesions, general edema and deterioration of general condition was hospitalized. Results from laboratory testing, cutaneous histopathology and immunohistochemistry showed a primary CGD-TCL. Staging was completed by a total body computed tomography. Therapy was planified with SMILE protocol. It is a highly aggressive tumor resistant to chemotherapy, immunotherapy, and radiation therapy. The GDTCL is characterized by a worse prognosis with a median survival of 15 months. Early diagnosis is essential and aggressive therapy is necessary.

Atteinte oculaire au cours de la périartérite noueuse. Deux observations

INTRODUCTION Polyarteritis nodosa (PAN) is a systemic vasculitis with polymorphic manifestations. Ocular involvement is rare; we report two such cases. CASES The first case was a 56-year-old man with PAN treated with corticosteroids. A year and a half later, during a disease outbreak associated with decreased visual acuity, ocular examination objectified a localized pigment epithelial detachment in the right eye. The outcome was favorable with corticoid bolus followed by azathioprine. The second case was a 41-year-old man presenting with PAN and decreased visual acuity. Ophthalmologic examination showed inferotemporal branch vein occlusion in the right eye with serous retinal detachments in the left eye. The outcome was favorable with intravenous cyclophosphamide followed by azathioprine. DISCUSSION The incidence of ocular involvement in PAN varies from 10 to 20%. It is most often associated with vasculitis of retinal and choroidal arteries. Fluorescein angiography is the gold standard of diagnosis. Multifocal acute ischemia of the choriocapillaris is very pathognomonic. Immunosuppressant drugs are effective and should be reserved for severe forms.

Hibernoma of the Neck

A 68-year-old man with no notable medical history presented with left cervical swelling that had been slowly increasing in size for 3 years. The patient was afebrile.

Acro-ostéolyse et polyarthrite rhumatoïde (une nouvelle observation et revue de la littérature)

Resumé:Introduction:L’acro-ostéolyse radiologique peut être secondaire à plusieurs affections. On différencie habituellement une forme idiopathique et des formes acquises. Parmi celles-ci, la polyarthrite rhumatoïde (PR) n’a été signalée qu’exceptionnellement.Observation:Nous rapportons le cas d’une patiente de 45 ans. Elle est suivie pour PR déformante et destructrice depuis 13 ans. Les radiographies et l’IRM des avant-pieds ont objectivé une ostéolyse bilatérale avec amputation des deuxièmes phalanges des gros orteils.Conclusion:L’acro-ostéolyse a été décrite dans la PR, soit d’une façon fortuite, soit en présence d’une vascularite, d’une neuropathie ou suite à une extension du processus rhumatoïde de l’articulation interphalangienne distale. Devant l’absence de ces anomalies, notre observation relance le débat sur la relation PR—acro-ostéolyse.Abstract:Introduction:Radiological acro-osteolysis can be secondary to several diseases. Idiopathic and acquired forms are usually differentiated. Among those, rheumatoid polyarthritis (RP) remains rare.Observation:We report the case of a 45 year-old female patient, who has been suffering from deforming destructive RP for 13 years. Radiological examinations and the MRI of the feet showed bilateral osteolysis with amputation of the second phalanges of the big toes.Conclusion:Acro-osteolysis was described in RP, either in a fortuitous way or in the presence of a vasculitis, a neuropathy or following an extension of the rheumatoid process from the distal interphalangeal articulations. In the lack of these abnormalities, through our observation, we discuss the relationship between RP and acro-osteolysis.

Une tuméfaction douloureuse de la cuisse

Un homme, âgé de 23 ans, était hospitalisé pour une tuméfacion douloureuse de la cuisse droite. En dehors de deux épisodes écents d’aphtose buccale, il n’avait pas d’autres antécédents. Il vait consulté trois semaines auparavant pour une douleur isoée, non fébrile, de la face interne de la cuisse droite, d’installation rogressive et apparue sans facteur déclenchant. Malgré les traiteents antalgiques, les douleurs devenaient majeures en 48 heures. l’examen clinique, on notait une tuméfaction de la cuisse droite ensible, pulsatile et soufflante à l’auscultation avec une adénoathie inguinale homolatérale. Il y avait une hyperleucocytose à 2 000 par millimètre cube à prédominance de polynucléaires neurophiles, la vitesse de sédimentation était à 50 mm à la première eure, la CRP à 40 mg/l. Il n’y avait pas d’autre anomalie biologique. n angioscanner corps entier était pratiqué (Fig. 1 et 2).