I. Rachdi

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

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.

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

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.

Tuberculous lymphadenopathy: About 36 patients

underlying pathology, they can reveal: immunodeficiency, infections, hemopathies, cancers and auto-immune diseases. The aim of this study was to investigate clinical, biological features and outcome characteristics of patients with hemophagocytic syndromes associated to severe infectious diseases. Methods: Its a retrospective study of patients with hemophagocytic syndrome associated to severe infectious diseases hospitalized in a Tunisian Internal Medicine department. Results: Hemophagocytosis was associated to severe infectious diseases in 6 cases, there were 2 cases of leishmaniasis, 2 cases of septicemia to Staphylococcus aureus, a case of septicemia to Escherichia coli and a case of lymph nodes tuberculosis with HIV. There were 4 men and 2 women. Mean age was 42.6 years (extremes between 20 and 56 years). The main clinicobiological features were fever and shivers noted in all the cases, hepato-splenomegaly were noted in 3 cases, peripheral lymph nodes in 2 cases and purpura in one case. There was hemorrhagic complication in 2 cases. Routine blood analysis confirmed an increase of inflammatory indices in all the cases. Five patients had pancytopenia and one had bicytopenia. High levels of lactic-dehydrogenases with hepatic cytolysis were noted in all the cases. Four of our patients developed intravascular disseminated coagulation. High levels of triglyceridemia were objective in 3 cases and there were hyperferritinemia in all the cases. Cytological examination of bone marrow confirmed hemophagocytosis in five cases. In one case, macrophage activation syndrome was retained on clinical and biological criteria. Cases of visceral leishmaniasis were treated by Glucantime® with a good clinical and biological outcome. In the case of lymph nodes tuberculosis, there was a good outcome. The other patients died. Conclusion: Among various aetiologies of hemophagocytic syndrome, infection is very important. The infectious agent responsible must be actively searched and rapidly treated to avoid poor evolution.