Faida Ajili

Malaria in Tunisian Military Personnel after Returning from External Operation

Introduction. Malaria had been eliminated in Tunisia since 1979, but there are currently 40 to 50 imported cases annually. Soldiers are no exception as the incidence of imported malaria is increasing in Tunisian military personnel after returning from malaria-endemic area, often in Sub-Saharan Africa. Methods. We retrospectively analyzed the clinical and biological presentations, treatment, and outcomes of 37 Tunisian military personnel hospitalized at the Department of Internal Medicine, the Military Hospital of Tunis, between January 1993 and January 2011, for imported malaria. The clinical and laboratory features were obtained from the medical records and a questionnaire was filled by the patients about the compliance of malaria prophylaxis. Results. Thirty-seven male patients, with a mean age of 41 years, were treated for malaria infection. Twenty-two were due to Plasmodium falciparum. The outcome was favourable for all patients, despite two severe access. The long-term use of chemoprophylaxis has been adopted by only 21 (51%) of expatriate military for daily stresses. Moreover, poor adherence was found in 32 patients. Conclusion. The risk of acquiring malaria infection in Tunisian military personnel can largely be prevented by the regular use of chemoprophylactic drugs combined with protective measures against mosquito bites.

Renovascular hypertension: A report of 21 cases

Renovascular hypertension (RVH) is among the most common forms of secondary hypertension. We studied 21 patients (eight male and 13 female) with RVH who were encountered during a period of 16 years. The average age of the patients was 34.75 years. Trans-renal Doppler ultrasound confirmed the diagnosis of renovascular stenosis (RAS) as the cause of RVH in 95% of the patients. Computed tomography angiography was performed in ten cases, which confirmed the diagnosis in all these cases. Magnetic resonance angiography was performed in only three patients. Renal scintigraphy was performed in 11 patients, with DTPA in nine patients and with MAG3 in two cases. Arteriography was performed in 15 cases for therapeutic end points. In two patients, we treated the arteries of both kidneys and in 19 cases we treated only one kidney artery. Percutaneous transluminal angioplasty was performed in ten cases. Renal arterial stent placement was performed in three cases in which RAS was from an atherosclerosis etiology. Surgical revascularization was performed in four cases. Nephrectomy was necessary in four cases. After interventional treatment, medical treatment using antihypertensive drugs was necessary in 17 of the patients. After treatment, three patients returned to normal kidney function, while worsening of glomerular filtration rate was noted in four patients. Some complications such as a kidney infarct after treatment, a nephrectomy, artery thrombosis, an ischemic stroke and recurrent RAS were also noted.

Perihepatitis in systemic lupus erythematosus.

We report the case of a 42-year old male patient was admitted to our hospital because of a two weeks history of severe dry cough and right upper quadrant pain. He had been diagnosed as LES with diffuse proliferative lupus nephritis (class IV) in 2006 treated intially by intravenous steroid pulse therapy combined with an immunosuppressant and benefited in 2007 of Hemodialysis. In July 2013, he suffered of constant abdominal pain located at the right upper quadrant with dry cough. C-reactive protein (CRP) was 17 mg/L (normal < 8 mg/L) on admission with positive antinuclear antibodies title at 1/1280. The chest-abdominal computed tomography scan showed a pleural effusion a regular hepatomegaly with a rim of enhancement involving the right lobe of the liver. No ascites was present and there was no ancillary evidence of cholecystitis. The findings were thought to be most consistent with a perihepatitis. Pleural fluid examination showed an exudative pleural effusion with a negative culture. The diagnosis of perihepatitis associated with SLE complicated by a right pleural effusion was taken. The patient condition was treated with two antibiotics (vibramycin and amikacyn) and oral prednisolone. On review 4 weeks later his pain, cough and the right pleural disappeared. Perihepatitis is a rare disease, normally associated with pelvic inflammatory disease. It has rarely been reported in association with systemic lupus erythematosus (SLE) particularly in patients with lupus hemodialysis nephritis.

Un anévrysme sacciforme de l'aorte abdominale révélant une maladie de Behçet: quand faut-il opérer?

Latteinte vasculaire est fréquente au cours de la maladie de Behçet. Elle est essentiellement représentée par les thromboses veineuses alors que latteinte artérielle est plus rare. Elle peut être isolée ou multifocale et peut toucher tous les territoires avec prédilection pour laorte abdominale, les artères pulmonaires et les artères des membres inférieurs. Latteinte anévrysmale de laorte abdominale est trompeuse se manifestant par une symptomatologie atypique responsable dun retard diagnostique favorisant la rupture. Dans notre cas, des douleurs abdominales paroxystiques ont incité le patient à consulter rapidement. Lenquête étiologique a conclue à un angio Behcet. Rarement, lanévrysme de laorte abdominale est révélé par une complication telle que la rupture dans le rétro péritoine ou le tube digestif. Les indications chirurgicales des anévrysmes de laorte sont discutées ici. Un traitement immunosuppresseur au long cours simpose en post opératoire pour limiter le risque de récidive.

Spinal Cord Compression Revealing an Intraosseous Schwannoma

A 68-year-old female presented with inflammatory lumbalgia and cruralgia. Physical examination revealed a lumbar stiffness without neurological deficit. Secondarily, paraplegia and urinary retention appeared. Magnetic resonance imaging showed a vertebral compaction of L3 vertebra with medullar compression. Emergent surgery revealed an epidural tumor involving largely the L3 vertebral body. Histology found schwannoma with positive protein S100 on the immunohistochemical study. Metastasis screening revealed bilateral nodular lesions of the lungs and a trochanter high scintigraphic signal. It was a malignant schwannoma. The patient underwent radiotherapy in addition to the total tumor resection.

La toxocarose peut-elle être responsable d’une pancréatite aigue?

Résumé La toxocarose humaine est une zoonose parasitaire cosmopolite causée par Toxocara canis et Toxocara catisqui sont des ascarides des chiens et des chats. C’est une affection le plus souvent bénigne. Nous rapportons un cas de pancréatite aigue dans le décours une toxocarose.Human toxocariasis is a cosmopolitan parasitic zoonosis caused by Toxocara canis and Toxocara cati which are roundworms of dogs and cats. It is mostly a benign condition. We here report a case of acute pancreatitis secondary to toxocariasis.

Severe metastatic calcifications in a hemodialysis patient

Tissue calcification is a common complication in patients on continuous hemodialysis (HD) for chronic renal failure; however, severe calcification is unusual. Three distinct clinical types of extraosseous calcifications are found in uremic patients: vascular calcification, periarticular (tumoral) calcification, and visceral calcification (heart, lung, and kidney). We report a case of a young chronic HD patient who presented with extensive metastatic calcifi cations both vascular, visceral specially localized in the lungs, and periarticular with progressively increasing multiple subcutaneous swellings. This evolution was secondary to noncompliance of the patient to the treatment of a malignant hyperparathyroidism with a marked elevation of phosphocalcium product.

Sarcoidosis with heart involvement: a rare association of terrible prognosis, a report of two cases.

Sarcoidosis is a multisystemic disorder of unknown etiology which is characterized by the formation of non-caseating granulomas in involved tissues. Cardiac involvement is one of the least common manifestations and it can occur at any point of time during the course of sarcoidosis. Here we present the case of 2 patients with known sarcoidosis who develop cardiac abnormalities in the absence of known primary cardiac cause. In our report, we would like to draw attention to the importance of considering heart involvement in any case with systemic sarcoidosis especially in young age.

Coexistence of pyoderma gangrenosum and sweet’s syndrome in a patient with ulcerative colitis

Pyoderma gangrenosum (PG) and Sweets Syndrome (SS) are inflammatory skin diseases caused by the accumulation of neutrophils in the skin and, rarely, in internal organs. These neutrophilic dermatosis (NDs) are distinguished by the existence of forms of transition or overlap. They are frequently associated to systemic diseases especially hematologic and gastrointestinal ones. We report a case of a patient with ulcerative colitis (UC) who successively developed two types of NDs: PG then SS. A 66 years old patient with a history of UC consulted in July 2012 for an erythematous swelling of the back of the right hand treated with antibiotics without improvement. At that time, bacteriological samples were negative. In October 2012, he was hospitalized for polyarthralgia and impaired general condition. In physical examination, he had vesiculobullous plaque of 10 cm long of the right hand and wrist, infiltrated erythematous plaque on the right leg and another topped with a large pustule at the left ankle. Skin biopsy showed at the back of the right hand an aspect of PG and at the infiltrated plaques of the ankle an aspect of SS. Prednisone was started with improvement of the skin lesions and a recovery condition. The combination of PG and SS has already been described in cases of hematologic malignancy and rarely in UC. There is also the notion of passage from a neutrophilic dermatosis to another. Indeed, a typical lesion initially of SS can evolve to a future PG. This case demonstrates that neutrophilic dermatoses form a continous spectrum of entities that may occur in UC.

Dermatomyositis Revealing Nasopharyngeal Carcinoma

Dermatomyositis (DM) may be an opening event of neoplasia. Nasopharyngeal carcinomas (NPCs) were rarely associated with this phenomenon. We report the case of a 42 year old patient with lilac table eyelid erythema lasting for six months with the notion of earache and recent epistaxis. The diagnostic inquiry concluded at a stage T2 N1 M0 NPC associated with DM. After 6 courses of chemo and radiotherapy skin symptoms disappeared completely with a clear regression of the tumor.