F. Daoud

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.

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.

Kaposi’s Sarcoma Presenting as Lymphadenopathy in an Immunocompetent Patient

Introduction Kaposi’s sarcoma (KS) is an angioproliferative disorder first described in 1872 by Moritz Kaposi. Four main clinical presentations of KS have been described: classic, endemic, iatrogenic and epidemic. KS involvement of the lymph nodes is extremely uncommon in the classical variant form, especially if it precedes the skin manifestations. We describe the case of an elderly HIV-negative patient presenting with lymphadenopathy who was found to have KS. Case Report A 67-year-old patient was admitted for exploration of polyadenopathies in the context of a general decline in health. Physical examination revealed an erythematosus left lower limb rash associated with angiomatous nodules and multiple lymphadenopathies. The diagnosis of erysipelas in the left leg was retained and the patient was treated with good evolution of the rash but persistence of the angiomatous nodules and the polyadenopathies. Skin and lymph node biopsies led to a diagnosis of KS. The patient is proposed for polychemotherapy. Conclusion KS must be suspected in lymphadenopathies despite the absence of typical cutaneous signs of the disease and in immunocompetent patients. LEARNING POINTS Involvement of the lymph nodes is extremely uncommon in the classical variant form of Kaposi’s sarcoma (KS). Human herpes virus-8 is an important cofactor in all forms of KS. Pathology and immunohistochemistry are key to diagnosing KS. KS must be suspected in lymphadenopathies without typical cutaneous signs of the disease and in immunocompetent patients.

Wegners Granulomatosis Revealed by Exophthalmos

Ophthalmic involvement is frequent, between 30% and 70% of patient’s present ophthalmic symptoms during the course of Wegner’s granulomatosis. Orbital disease may present initially before the onset of systemic manifestations in only 8 to 16% of patients and it could delay final diagnosis. We report a case illustrates the diagnosis of Wegner’s granulomatosis presenting with proptosis (exophthalmos) of the orbit. Patient was treated with corticosteroid and intravenous cyclophosphamide (CYC) with good response. This case emphasizes early diagnosis and treatment to avoid further complications

AB0935 Clinical Characteristics of Tuberculous Spondylitis: About 13 Cases

Background Osteo-aticular tuberculosis represents 2 to 5% of all tuberculosis. Tuberculous spondylitis arise at any age. Dorsolumbar location is most frequently touched and clinical presentation is not specific. The MRI presents a superior to other radiological exams in the exploration of tuberculous spondylitis. Objectives The purpose of our study is to specify epidemiological, clinical, biological and therapeutic peculiarities of Tuberculous Spondylitis in Tunisian patients. Methods A retrospective and descriptive analysis including patients with tuberculous spondylitis followed in the department of internal medicine during a period of 15 years from January 2000 till January 2015. Tuberculin skin test, imaging techniques, mycobacterium cultures, histopathologic examination, treatment and clinical outcome were reported. Diagnosis was retained in front of positive bacteriological or histopathological exams and/or association of clinico-biological or radiologic arguments with therapeutic proof. Results We identified 13 patients with tuberculous spondylitis. It was about 9 women and 4 men with a middle-age at the time of diagnosis of 53, 4 years with extremes between 13 and 90 years. The mean diagnosis delay was 7,4 months. Main initial symptoms were back pain in 11 cases, mobility limitation in 6 cases and dysphagia in a case. Blood tests showed leukocytisis in a case an elevated C-reactive protein levels in 9 cases. Tuberculin skin test was positive in 7 cases. Bacterial diagnosis was positive in a case. Granuloma with necrosis was noted at the histopathologic examination of the bonedraining biopsy in 3 cases. Radiologic exams contained standard spinal radiographs in 7 cases, Computed tomography scanning in 7 cases and magnetic resonance imaging in 6 cases. The imaging examination showed signs of lytic destruction of vertebral body with vertebral collapse in all cases, and multiple abscesses in 5 cases. Spondylitis was located in thoracic vertebra in 6 cases, lumbar vertebra in 6 cases and cervical vertebra in a case. Other locations of the tuberculosis were noted in 5 cases and were represented by lymph nodes, meningeal, peritoneal, retropharyngeal and urogenital tuberculosis. All the patients were treated by a tuberculosis quadritherapy. A patient received corticosteroids for spine involvement. The median duration of the treatment was of 16 months. The outcome was favourable in all cases with stabilization of the radiological involvement. The mean follow up was of 15,7 months Conclusions Tuberculosis always rages under an endemic mode in developing contries. Inspite of the absence of immunosuppression, tuberculosis spondylitis was associated to other tuberculous locations in 5 cases. The beginning is often insidious with a late diagnosis. The association of clinical, biological and radiological arguments with therapeutic proof allowed to carry the diagnosis. Disclosure of Interest None declared

P-205: Nephrotic syndrome revealing Hodgkin’s disease

OBJECTIFS The association between paraneoplasic nephrotic syndrome and Hodgkins disease is rare estimated to be about 0.5 to 1% (0.4% as minimal change disease and 0.1% as amyloid). MéTHODES: We report the case of an Hodgkins disease revealed by an isolated nephrotic syndrome. RéSULTATS: A 34-year-old man presented with the clinical symptoms of nephrotic syndrome, Physical examination was notable for lower extremity edema. Though his hematologic evaluation was consistent with anemia (white blood cells = 11300/mm(3); hemoglobin, 7,9g/dL; platelets, 482000/mm(3)), there was no evidence of hemolysis but a biologic inflammatory syndrome. Nephrotic range proteinuria (3,4g in 24 hours), acute renal failure (creatinine 160umol/L), and hypoalbuminemia (23g/L) were also present. Kidney biopsy revealed endocapillary proliferative glomerulone-phritis associated with vasculitis. A treatment with prednisone was started with favorable response. Two months after the diagnostic of nephrotic syndrome was made, the patient presented prolonged fever and weight loss. The physical examination showed cervical lymphadenopathy, which lymph node biopsy revealed Hodgkin lymphoma of the nodular sclerosing type. The patient was treated for Hodgkin disease stage IVB with ABVD regimen, and was in complete remission of both Hodgkins disease and nephrotic syndrome. CONCLUSION Causes of nephrotic syndrome in Hodgkins disease can include renal vein thrombosis, amyloidosis or paraneoplastic syndrome. This case attracts attention that a rare cause of nephrotic syndrome can be Hodgkins disease.

Simultaneous Occurrence of Systemic Lupus Erythematosus, Rheumatoid Arthritis, Hashimoto’s Thyroiditis and Membranous Glomerulonephritis

Introduction: Membranous glomerulonephritis is commonly described in systemic lupus erythematosus (SLE) and hypothyroidism. Clinical presentation: We report a case of a 40-year-old woman who presented with a membranous glomerulonephritis associated with SLE, rheumatoid arthritis and hypothyroidism due to Hashimoto’s thyroiditis. Conclusions: The simultaneous occurrence of these three diseases as possible causes of membranous glomerulonephritis is extremely exceptional.

Granulomatosis with Polyangiitis (Wegener Granulomatosis) Mimicking Infective Endocarditis

Introduction Infective endocarditis (IE) has been reported to mimic granulomatosis with polyangiitis (GPA) and to test positive to antineutrophil cytoplasmic antibodies (ANCA), which may lead to a misdiagnosis and inappropriate treatment. Case presentation We report a case of a 59-year-old man admitted for purpura, gangrenous digital infarcts and glomerulonephritis. The diagnosis of IE was initially considered on the basis of heart murmur and two positive haemocultures to corynebacterium. Ineffectiveness of antimicrobial therapy and further neurological and nasal manifestations supported the diagnosis of GPA. Conclusions IE should be ruled out before initiation of immunosuppressive treatment. If the disease progresses despite antimicrobial treatment, vascular diseases should be rapidly taken into account in differential diagnosis and treated early to avoid fatal complications.

A Rare Manifestation of Crohn's Disease: Sinonasal Granulomatosis. Report of a Case and Review of Literature

Crohn’s disease is a granulomatous inflammatory bowel disease. Its pathologic findings include non-contiguous chronic inflammation and non-caseating granulomas, sometimes with extra-intestinal localizations. Sinonasal manifestations of Crohn’s disease are quite rare and only a few cases have been reported up to date in the worldwide literature. They are characterized by chronic mucosal inflammation, obstruction, bleeding and occasionally septal perforation. We report a case of sinonasal granulomatosis revealing Crohn’s disease in a 22-year-old woman and go over the available literature on sinonasal involvement in Crohn’s disease.