Geoffrey C. Colin

IMPORTED MALARIA IN A TERTIARY HOSPITAL IN BELGIUM: EPIDEMIOLOGICAL AND CLINICAL ANALYSIS

Abstract Background and objective: There has been a marked increase in tourism, immigration, and business travel to malaria-endemic areas. Non-immune individuals (western travellers) or immigrants living for more than one year in non-endemic areas who visit friends and relatives (VFR) are particularly susceptible to developing severe malaria when travelling to areas with high levels of transmission. In this study, epidemiological, clinical and biological features of malaria in travellers returning from endemic areas were analysed. This may help clinicians unfamiliar with malaria not to overlook this disease in its early stage, and to initiate prompt treatment. Patients and methods: we retrospectively analysed all cases of patients who presented with malaria in our institution between 2003 and 2008. Results: Eighty patients were included. Most patients visited Africa (93.6%). Accordingly, P. falciparum was the main species identified (67/77 patients i.e. 87%). Sixty-five patients (65/78 i.e. 83.3%) had not taken any prophylaxis and 13 (16.7%) had taken it inadequately. Common clinical features were fever (80/80, 100%), influenza-like symptoms (16/80, 20.1%), respiratory symptoms (5/80, 6.3%), neurological symptoms (2/80, 2.5%) or digestive symptoms (15/80, 18.8%). Digestive symptoms were predominant in children < 16 y.o. (60% of these patients). Conclusion: Imported malaria cases are mostly related to the lack of adequate use of chemoprophylaxis. Plasmodium falciparum is the main species responsible for imported cases of malaria in our institution. Clinical features vary, but fever is universally present at presentation. As such, all cases of fever upon return from a malaria-endemic area must be considered as malaria until proven otherwise, at least during the first three months after the return.

Asymptomatic Late Migration of an Atrial Pacemaker Lead into the Right Lung

This report illustrates an unusual case of asymptomatic late cardiac perforation by an atrial pacemaker lead into the right lung. In the present case, the lead was explanted by simple manual traction through the device pocket without any complications.

Unexpected 'pulmonary hypertension' in a patient with granulomatosis with polyangiitis.

A 62-year-old woman presented with increasing dyspnoea for 3 months. She had a known history of granulomatosis with polyangiitis (GPA) that was diagnosed upon biopsy of an interauricular septal mass revealed by a third-degree AV block 6 years earlier leading to implantation of a pacemaker. At current admission, transthoracic echocardiography showed a maximal systolic pressure gradient of 65 mmHg between the right …

Atrio-oesophageal fistula following atrial fibrillation ablation procedure: diagnosis with cardiac CT

A 74-year-old woman had an atrial fibrillation (AF) ablation procedure. Three weeks later, she presented with sepsis and paresis of the left upper limb. Initial chest computed tomography (CT) was inconclusive (Fig. 1a, b). Brain magnetic resonance imaging (MRI) showed acute multiple embolic cerebral infarcts (Fig. 1c, d). An atrio-oesophageal fistula (AOF) was suspected. ECG-gated CT was performed (Fig. 1e, f ), confirming the diagnosis. AOF should be considered in case of fever, neurological deficit or haematemesis following an AF ablation procedure. Transoesophageal echocardiography and oesophagogastroduodenoscopy are contraindicated because of risk of air embolization during these procedures. As a result of the subtle abnormalities in the left atrium and the cardiac motion, diagnosis with routine chest CT might be difficult. This case highlights the added value of cardiac CT in diagnosis of AOF, therefore allowing us to treat this serious complication.

Good's syndrome: Clinical and imaging presentation

The association of hypogammaglobulinemia with thymoma is called Good’s syndrome (GS) [1]. This rare immunodeficiency paraneoplastic syndrome occurs in 5—10% of thymomas [2] and carries a relatively poor prognosis. Computed tomography (CT) may be helpful to suggest the diagnosis. A 51-year-old man underwent complete surgical resection of a non-invasive AB type thymoma (Masaoka stage II) (Fig. 1). Six months later, the first postoperative chest CT showed mild bronchiolar infiltrates in the right lung with a ‘‘tree-in-bud’’ pattern and bronchial wall thickening. The patient was then asymptomatic. In the same year, the patient started to develop severe chronic sinusitis, repeated pulmonary infections and cutaneous mycosis. Blood tests revealed a pure red cell aplasia (PRCA), a serum, hemoglobin level of 8 g/dl, and hypogammaglobulinemia with low IgG2 and IgG3 levels. He was treated monthly with intravenous immunoglobulin replacement (IVIG) and oral corticosteroid therapy to treat the PRCA. Whereas hemoglobin and immunoglobulin levels returned

STEMI revealing an exceptional variant of single right coronary artery.

A 58-year-old man with hypercholesterolaemia was admitted for acute coronary syndrome with ST-segment elevation in inferior ECG derivations and ST-segment depression in antero-lateral ECG derivations ( Panel A ) . The patient underwent emergency coronary catheterization. Subtotal occlusion of the third segment of the right coronary artery (RCA) (Supplementary data online, Movie …

Pulmonary metastasis of uterine leiomyosarcoma presenting as centrilobular nodules with "tree-in-bud" pattern.

A 59-year-old woman had a chest and abdominal CT scan as part of a staging assessment for uterine cancer. The investigation was negative except for a small cluster of micronodules in the left upper lobe centred around branched linear opacifications in continuity with the peripheral pulmonary arteries (Fig. 1). The sub-pleural space was preserved. These were therefore centrolobular micronodules with a ‘‘tree-in-bud’’ appearance suggesting a respiratory cause such as bronchiolitis. The patient was immunocompetent and had no respiratory symptoms however, and her laboratory tests showed no signs of inflammation. A PET-CT scan was performed and showed moderate hyperintensity at this point with a max standardized uptake value (SUV) of 4.75 (Fig. 2a). In view of the context of malignancy, a transthoracic lung needle biopsy was performed (Fig. 2b) at 6 weeks using an 18 Gauge Coaxial system (Quick-Core, Cook®). The procedure was uncomplicated and histological examination (Fig. 3) showed a proliferation of fusiform cells with a high mitotic index. By immunohistochemistry these tumour cells expressed smooth muscle markers including alpha-actin and were negative for epithelial markers. This analysis therefore confirmed a metastatic site of the uterine cancer, a high-grade leiomyosarcoma.