E Monlun

Cardiac complications of halofantrine: a prospective study of 20 patients

Halofantrine, increasingly used for treatment of Plasmodium falciparum malaria, is a normally well-tolerated amino-alcohol with very few side-effects, but torsades de pointes ventricular tachycardia due to halofantrine has been reported in a few patients with a congenital long QT interval (Romano-Ward syndrome). We performed a prospective study of the cardiac effect of halofantrine in 20 patients with 48 h ambulatory electrocardiographic (ECG) monitoring; the halofantrine levels in their serum were also determined. Minimal ECG changes were noted, with lengthening of the QT interval without clinical symptoms. This effect was dose-dependent and can be very severe in cases of pre-existing cardiopathy; it also occurs in patients without any pre-existing cardiopathy. In order to reduce the likelihood of such incidents, which are admittedly rare, we suggest performing electrocardiography on all patients before initiating treatment with halofantrine.

Concurrent herpes simplex type 1 necrotizing encephalitis, cytomegalovirus ventriculoencephalitis and cerebral lymphoma in an AIDS patient.

Unlike cytomegalovirus (CMV) ventriculoencephalitis, herpes simplex virus type 1 necrotizing encephalitis has only rarely been observed in AIDS patients. A 40-year-old bisexual man was followed for an HIV1 infection from 1987 onwards. In June 1993 he was referred for sudden confusion, left hemiparesia and fever. The blood contained less than 10 CD4 lymphocytes/mm3. The patient remained comatose and febrile, and died 4 weeks later. In coronal sections of the brain there was necrosis of the internal parts of the left temporal lobe, necrosis of certain areas of the ventricular walls and a small tumor at the top of the right frontal lobe, which proved to be a polymorphic high-grade lymphoma. CMV ventriculoencephalitis lesions were prominent in the ventricular walls of the oecipital lobes and there was a strong nuclear signal for CMV using in situ hybridization. Herpes simplex virus type 1 was shown in the nuclei and cytoplasm of certain neurons and astrocytes in the borders of the necrotized temporal lobe areas by immunohistochemistry, in situ hybridization and electron microscopy, whereas in situ hybridization and immunohistochemistry for CMV were negative in such areas. Necrotizing type 1 encephalitis must not be overlooked in immunodeficient patients.

Aspects épidémiologiques, cliniques, biologiques et évolutifs de la leptospirose : à propos de 30 observations recueillies en Aquitaine

Thirty cases of leptospirosis serologically proved, are reviewed: contaminating circonstances were often determined. We observed mainly: acute fever, myalgia, jaundice, hemorrhages and acute renal failure (7 hemodialysis). Two patients died (acute respiratory failure, meningo-encephalitis with hemoptysis).

La toxocarose en Médecine Interne: enquête de séroprévalence chez 100 patients hospitalisés

Human toxocariasis is highly prevalent in France. We here report a seroprevalence study in 100 successively hospitalized adults. Diagnosis was performed by ELISA and Western blot. 17 percent were found positive without clinical or biological specific symptoms.

Manifestations articulaires et infections à parvovirus B19: 8 observations

Human Parvovirus B19 (PB19) may cause joint manifestations. We report eight cases of polyarthritis associated with PB19 IgM: six cases of acute polyarthritis spontaneously resolving within a few days, and two other cases suggesting that PB19 should be responsible for accutisation of chronic disease (lupus with Kikuchis disease and HLA B27 related arthritis).

Épidémiologie et pathogénie atténuée du virus dengue 2 en Afrique de l'Ouest

Dengue 2 virus was isolated in West Africa from vectors, from men and from one monkey. The isolation of these strains suggests a sylvatic cycle, without shock or hemorrhage in men. Molecular biology works showed genotypic community between these african strains, emphasizing the attenuated pathogenicity of the dengue 2 virus in Africa.

Tuberculose hépatique autonome à forme pseudo-tumorale

Summary We report a case of isolated pseudo-tumoral hepatic tuberculosis. The patient, from Marocco and non immunocompromised (HIV seronegative) presented with persistant fever and right abdominal pain. CT scan discovered an intrahepatic tumor, and anatomopathology confirmed tuberculosis without others localisations. The patient remained clinically well after antibiotic specific treatment.

Une cause rare d'éosinophilie paroxystique: la gastroentérite à éosinophiles

The authors report the case of a 16 year-old boy admitted for the seventh acute occurrence in 18 months of abdominal pain associated with hypereosinophilia. Each episode was identical in nature and receded spontaneously after 5 or 6 days. Biopsy of a fiber colonoscopically obtained specimen of small intestine was performed. The diagnosis of eosinophilic gastroenteritis was based upon an infiltration of the digestive mucosa by eosinophils, the absence of elements in favor of other types of digestive-tract disease (parasitic, allergic, hematologic, or inflammatory), and the absence or other illness outside the digestive system. However, the incidental discovery of a distal dilation of both of the patients ureters during one such episode, that disappeared with the other symptoms, raises the possibility of a bladder location as well, and thus of a hypereosinophilic syndrome. Corticoids were administered then tapered down. A relapse occurred 2 months later. Currently, he is taking 20 mg of a corticoid every other day and has presented no manifestations over the last 9 months.

Arythmies ventriculaires et prise d'halofantrine: 3 observations

We report three cases of long QT-interval due to halofantrine: three different young women took halofrantrine and all presented with syncopal episodes and several bursts of torsades de pointes . In 2 cases electrophysiological cardiac tests concluded that they had a congenital long QT-interval (Romano-Ward Syndrome). In spite of the rarity of the congenital Romano-Ward syndrome, systematic electrocardiogram is necessary before giving halofantrine.

Fasciites de shulman: 3 observations

We describe three cases of eosinophilic fasciitis, two women and one man who presented with edematous syndrome and hypereosinophilia. A parasitologic disease was first suspected, emphasizing the diagnosis difficulties.