Kaouther Ben Abdelghani

Chronic Inflammatory Rheumatism Associated With Takayasu Disease

Takayasu disease is rarely associated with other autoimmune diseases. Therefore, the cases discussued herein are uncommon because we are reporting Takayasu disease associated with rheumatoid polyarthritis and spondylarthropathy. The first case concerns a 40-year-old woman presenting with Takayasu disease 11 years after the diagnosis of erosive and seronegative rheumatoid polyarthritis. The upper limb arteries and 1 lower limb artery were affected. The second 41-year-old case presented with ankylosing spondylitis that had been evolving for 10 years. Human leukocyte antigen-B27 typing was negative. Takayasu disease was revealed by severe high blood pressure. In both cases, radiologic examination revealed a typical aspect of the aorta and its main collaterals. Rarely in the literature have these associations been reported, and the pathology remains unknown.

Reactive arthritis induced by intravesical BCG therapy for bladder cancer

Cancers of the bladder could be treated with intravesical instillation of BCG therapy. This treatment could lead to some complications. Osteoarticular ones are relatively uncommon. We describe an original observation, illustrating the development of reactive arthritis after intravesical BCG therapy. A 60-year-old man was followed for a T1G3 transitional papillary carcinoma of the bladder and was treated with intravesical BCG immunotherapy. Within the sixth intravesical instillation, he presented with polyarthritis confirmed by musculoskeletal ultrasound. The erythrocyte sedimentation rate was 100 mm without leukocytosis. The viral and bacterial serologies and immunological tests were negative. The ophthalmological examination revealed left conjunctivitis. Treatment with non-steroidal anti-inflammatory drugs was started, combined with the discontinuation of the intravesical instillation. No recurrence has been reported with a current decline of 2 years.

Collagenous colitis and spondylarthropathy.

Collagenous colitis is a recent cause of chronic diarrhea. Cooccurrence with spondylarthropathy is rare. We describe two cases: one man and one woman of 33 and 20 years old were suffering from spondylarthropathy. They then developed collagenous colitis, 4 and 14 years after the onset of spondylarthropathy. The diagnosis was based on histological features. A sicca syndrome and vitiligo were observed with the female case. The presence of colitis leads to therapeutic problems. This association suggests a systemic kind of rheumatic disease of collagenous colitis.

Takayasu's arteritis occurring under TNF-α blockers: a new paradoxical effect?

Takayasu’s arteritis (TA) is a rare granulomatous vasculitic disease. Recently, experimental studies and several case reports have supported the use of anti-tumour necrosis factor (TNF) therapy for severe forms of TA. We report a case of a 58-year-old woman who was followed for spondyloarthritis. Her disease was resistant to non-steroidal anti-inflammatory drugs, and TNF-α blockers were initiated. The patient developed asthaenia and severe back pain. The erythrocyte sedimentation rate was 82 mm and C reactive protein was 192 mg/L. Based on thickened walls of large vessel on MRI, a diagnosis of TA was established. Under corticosteroids and after discontinuation of TNF-α blockers, the patient remained free of symptoms at 8-month follow-up.

Retinal vasculitis: a novel paradoxical effect of anti-TNFα?

Retinal vasculitis (RV) is extremely rare in spondyloarthritis associated with Crohns disease. Infliximab, a chimeric monoclonal antibody to tumour necrosis factor (TNF) α, is efficient in spondyloarthritis, Crohns disease and RV. We present the case of a 41-year-old man with a known history of spondyloarthritis associated with Crohn’s disease. He was under treatment with infliximab. Four days after his 12th infusion of infliximab, he presented with sudden blurred vision. Although his disease was in remission, ophthalmological examination revealed bilateral peripheral retinal occlusive vasculitis. The patient responded positively to the treatment by laser photocoagulation and peribulbar corticosteroid injection. Infliximab was not stopped. There was improvement in his eye disease. To the best of our knowledge, this is the first case of new onset of RV occurring under infliximab in a patient with Crohns related spondyloarthritis. This case illustrates the possibility of a paradoxical effect of this kind of therapy.

Metatarsal Brodie's abscess in a Tunisian child

Brodies abscess is a subacute or chronic variant of osteomyelitis usually involving the metaphysis of long bones. The clinical presentation is often atypical and the diagnosis is challenging. It is rare except in developing countries. A 10-year-old Tunisian girl reported left metatarsalgia with loss of motion evolving since 3 weeks. One month previously, she had suffered from rhinopharyngitis. On examination, the temperature was 38.5°C. There was tenderness and swelling …

Renal cell carcinoma: an unusual case of sclerotic metastasis.

A 44-year-old man presented with a 3-month history of low back pain affecting mainly the left lumbar and gluteal regions. Physical examination revealed restricted back movement with tenderness over lumbar spinal processes. Straight leg raising test was negative. Laboratory examinations showed an elevated erythrocyte sedimentation rate (ESR; 116 mm) and a high level of alkaline phosphatase (1000 IU/L). Serum levels of calcium, albumin and phosphorus were within the normal range. The pelvis and …