F. Boussema

Un insulinome géant : à propos d’un cas

Islet-cell tumors are the most common neuroendocrine tumors that arise from the endocrine pancreas. They are typically benign and sporadic. Diagnosis is generally established late because clinical signs lack specificity. The insulinoma is difficult to localize since it is very small in size, often not exceeding 2cm. We report an exceptional case of giant insulinoma initially revealed by a pseudo-polycythemia in an 80-year-old man. He had been treated for hypertension for a few months. Routine biological investigations showed elevated hematocrit and haemoglobin, suggesting Vaquez disease. History taking revealed recent episodes of nocturnal agitation. On admission, he had reddish skin with a suspected enlarged spleen, but total blood volume was normal. Imaging studies showed a voluminous tumor located between the pancreas and the spleen. The presence of an insulinoma was confirmed on the basis of an elevated level of proinsulin at the time of an asymptomatic episode of hypoglycemia. Spleno-pancreatectomy was performed. Histopathological examination revealed a malignant, well-differentiated neuroendocrine malignant tumor.

Anévrisme pulmonaire complètement résolu après un traitement médical au cours de la maladie de Behçet

Pulmonary artery aneurysm in Behcet disease compromises seriously the diagnosis since its fatal rupture is still the major cause of death in this disease. Pulmonary artery aneurysm requires urgent management and several treatments have been proposed, including steroids, immunosuppressive drugs, embolisation and surgery. Herein, we report a patient with Behçets disease in whom multiple pulmonary artery aneurysms were completely resolved after a combined treatment with corticosteroids and azathioprine. Pulmonary artery aneurysms in Behçets disease are reported to indicate poor prognosis and high mortality. Computed tomographic scans of the chest and angiography are the most common diagnostic procedures used in the diagnosis or evaluation of pulmonary artery aneurysm. Immunosuppression is the main therapy for the treatment of a vasculitis.

Mucormycose parotidienne : une nouvelle observation et revue de la littérature

INTRODUCTION Mucormycosis is a rare, devastating, fungal infection, which disproportionately affects non-controlled diabetic patients, notably during ketoacidosis. The authors report the case of cervical mucormycoses with a particularly favorable evolution in diabetic woman. REPORT A 54-year-old woman, type 2 diabetic, had presented a left lateral cervical mass. The diagnosis was confirmed by histological examination. She was treated with Amphotericin B with favorable evolution. CONCLUSION The mucormycose is a rare infection. The treatment is medical and surgical. The prognosis is severe with an overall mortality rate of 40%.

AB0709 Association of tinu, nodal tuberculosis and renal amylosis

Background Tubulo-interstitial nephritis may be caused by drugs, infections or systemic diseases. However, the precise cause and etiology of the disease are unclear. Uveitis is a general terme of the inflammation of the iris and choroid. This ocular disorder is known to be complicated with several systemic disorders such as sarcoîdosis, Behecet’s disease and toxoplasmosis. The association of tubulo-interstitial nephritis and uveitis (TINU) was first described in 1974. Subsequently, Dobrin et al reported two cases of interstitial nephritis complicated with anterior uveitis. Since then, this association has become known as Dubbin’s syndrome. Objectives We present a case of TINU associated with nodal tuberculosis and renal amylosis. Results A 68-year-old woman with 4 months history of nodal tuberculosis diagnosed on histological study of cervical nodal biopsy was referred to our department for painful red eye and decreased vision in both eyes. Physical examination was unremarkable except for the bilateral red eye. Ophtalmological examination objective revealed bilateral non-granulomatous anterior uveitis. Laboratory finding was normal except for proteinuria (1g/24h). Urinary cytobacteriologicalexam showed aseptic leukocyturia. Antinuclear and antineutrophil cytoplasmic antibody test results were negative. Serological tests of infectious were negative. An ophthalmological examination revealed bilateral non-granulomatous anterior uveitis. Abdominal ultrasonography was normal. Histopathological examination of kidney biopsy showed amyloid deposits and tubulo-intersitial nephritis. Diagnosis of TINU was made. The patient was treated with antitubercular drugs. Eight months later, 24h urinary protein gets better and uveitis improved. Conclusions TINU syndrome no longer appears to be so rare, but its mechanism remains unclear. It should be considered as differential diagnosis of unexplained tubule-interstitial nephritis especially in the presence of ocular finding. Disclosure of Interest None Declared

Ectopic Axillary Breast during Systemic Lupus.

Many breast changes may occur in systemic lupus erythematosus. We report a 41-year-old woman with lupus who presented three years after the onset of lupus an ectopic mammary gland confirmed by histological study.

HYPERTENSION IN TAKAYASUʼS ARTERITIS: PP.38.493

Introduction and Purpose: Takayasus arteritis is a rare chronic inflammatory disease, which normally affects the aorta and its main branches, and less often, the pulmonary arteries. Hypertension is common in Takayasus arteritis and may be related to changes of vascular compliance, renal vascular ischaemia with hypereninaemia or increased sensitivity of the carotid body. The aim of our study was to determine the etiologic profile of hypertension in Takayasus disease. Patients and Methods: We carried out a retrospective study of 7 cases of Takayasus arteritis admitted to our department from January 1999 to April 2009. Diagnosis was established according to the classification criteria of the American College of Rheumatology (ACR) in 1990. Results: Seven women were studied; mean age at diagnosis was 34, 57 years. Classification criteria were abnormal arteriography in 100% of cases, diminished brachial pulses in 100%, vascular bruits in 85%, claudication of lower limbs in 57%, difference of blood pressure between arms (>10mmHg) in 57% and age <40 years in 85%. Mean clinical manifestations were malaise in 42%, syncope in 14%, acute cerebrovascular accident in 14%, arthralgia in 28% and visual disorders in 28% of cases. Hypertension was noted in 4 cases (57%). The mean age was 25.5 years (21 – 35 years). In the 4 cases arteriography was abnormal showing renal artery stenosis. Stenosis was bilateral in one case. In one case, the patient was admitted for malignant hypertension and the diagnosis of TA was making. All patients were treated with calcic blokers drugs in association with specific treatment. The chirurgical treatment was angioplasty of the left renal artery in one case and by-pass of the left renal artery in one case. Conclusion: The diagnosis and treatment of hypertension in this disease is imperative, as the commonest causes of death are congestive heart failure, myocardial infarction and strokes, while retinopathy and severe systemic hypertension are predictive of increased mortality.

Cervical Pott's disease revealed by retropharyngeal abcess

montrait une raréfaction des plissements duodénales puis faire é, un t sera [12] Changela K, Safai Haeri N, Krishnaiah M, Reddy M. Plummer-Vinson Syndrome with proximal esophageal web. J Gastrointest Surg 2016;20 (5):1074–5. http://dx.doi.org/10.1007/s11605-015-3051-3055. [13] Bakari G, Benelbarhdadi I, Bahije L, El Feydi Essaid A. Endoscopic treatment of 135 cases of Plummer-Vinson web: a pilot experience. Gastrointestinal Endoscopy 2014;80(4):738–41. Lettres à la rédaction

59 Antiphospholipid syndrome: about 62 cases

Background and aims The antiphospholipid syndrome (SAPL) is an autoimmune and thrombogenic pathology that the diagnosis is based on clinical and biological criteria. It can be isolated (primary SAPL) or associated with another auto-immune disease (secondary SAPL). The purpose of this work is to finalise the epidemiological, clinical, biological, characteristic. Methods We led a retrospective and descriptive study of the patients followed in the service of internal medicine for SAPL between January 1990 and April 2014. Results We brought together 62 cases ( 61 women and 1 man). The average age was 41 years.The peripheral thromboses were observed in 51.6%. The obstetric accidents were found at 26 patients dominated by repeated abortion (35.5%) and fetal death in uterus (16.1%). The cardiac infringement was dominated by valvular disease in 9.6%. The lung demonstrations were represented by a pulmonary embolism in 32.25% and a lung arterial high blood pressure in 19.3%. The neurological infringement was present in 29%. The SAPL was primary in 32% and secondary in 86%. The CAPS was found in 2 cases. The SLE was present in 59.7%. The immunological balance sheet revealed aCL in 77.4%, anti-ß 2GPI in 24.2% and anti-PT in 17.7%. a statistically significant correlation between the obstetric and vascular sign with the presence of aCL. Conclusions The SAPL is an entity among which the knowledge and the understanding are in permanent evolution. It is necessary to think of it in front of any vascular reccurent thrombosis to a young subject.

Des calcifications diffuses

Une femme, âgée de 22 ans, était suivie depuis cinq ans pour une ermatomyosite avec un atteinte musculaire et cutanée typique épondant aux critères de Bohan et Peter. Elle avait été traitée par orticoïdes puis méthotrexate. Deux ans après le début de la malaie, elle développait des indurations sous-cutanées, diffuses des embres et du tronc, évoluant par poussées itératives et non améiorées par colchicine et inhibiteur calcique (diltiazem). Le bilan hosphocalcique était sans anomalie. Un amaigrissement récent aisait réaliser un scanner thoraco-abdomino-pelvien à la recherche ’une néoplasie associée (Fig. 1 et 2).

Particularités épidémiologiques, cliniques et évolutives des pneumopathies interstitielles au cours de la sclérodermie systémique

Pulmonary involvement during systemic sclerosis (SS) is dominated by interstitial lung disease and arterial pulmonary hypertension. It is about a retrospective study analyzing 65 cases of SS over a period of 13 years. We compared cases with and without interstitial lung disease. The diagnosis of SS was retained according to American College of Rheumatology (ACR)/EULAR 2013 criteria. The diagnosis of interstitial lung disease was retained in TDM and EFR. Pulmonary hypertension is defined by a pulmonary arterial pression higher than 25 mmHg. The mean delay of diagnosis of interstitial lung disease and the diagnosis was of 48 months (extremes 0-78 months). The comparison between both groups according to average age of the patients, prevalence of pulmonary hypertension, frequency of Raynaud phenomenon and trophic disorders did not find any significant difference. Lung involvement was associated with an esophageal involvement in 71% of the cases (P=0.059). Antibodies anti-Scl 70 were noted more frequently in patients with interstitial lung disease (79% of the cases, P=0.001). Patients were treated with colchicine and vitamin E. A corticotherapy had been indicated at a single patient. The evolution of SS was marked by the stabilisation of the restrictive syndrome in 71.8% of the cases and a worsening in 25% of the cases. Early and appropriate diagnosis of SS and screening of lung involvement are essential for a early care.