L. Rokbani

Profil étiologique des nécroses digitales des membres supérieurs : analyse de 25 observations

AIM To investigate the etiologies of the upper limb digital necrosis based on a retrospective analysis of 25 cases. PATIENTS AND METHODS We retrospectively reviewed the medical records of patients treated for digital necrosis of the upper limb in four departments of internal medicine from January 1997 to December 2003. RESULTS There were 16 women and nine men, mean age 55 years. Eleven patients were smokers. Raynauds phenomenon was noted in 12 cases. Connective tissue diseases were the most common cause (nine cases), all of them were women. The second cause was atherosclerosis (five cases) and Buergers disease (five cases). In the other cases, the following diagnoses were found: vasculitis (three cases) and neoplasm (two cases). No cause could be identified in one female smoker. CONCLUSION Digital necrosis is a common symptom, revealing a vascular pathology. Its causes are diverse. In women, it first suggests a connective tissue disease whereas in men, a diffuse arteriopathy. The etiological diagnosis strategy should consider drug intake, anamnesis and Raynauds phenomenon history. However, in all cases the etiology investigations should not delay the treatment in order to preserve functional prognosis.

Un insulinome géant : à propos d’un cas

Islet-cell tumors are the most common neuroendocrine tumors that arise from the endocrine pancreas. They are typically benign and sporadic. Diagnosis is generally established late because clinical signs lack specificity. The insulinoma is difficult to localize since it is very small in size, often not exceeding 2cm. We report an exceptional case of giant insulinoma initially revealed by a pseudo-polycythemia in an 80-year-old man. He had been treated for hypertension for a few months. Routine biological investigations showed elevated hematocrit and haemoglobin, suggesting Vaquez disease. History taking revealed recent episodes of nocturnal agitation. On admission, he had reddish skin with a suspected enlarged spleen, but total blood volume was normal. Imaging studies showed a voluminous tumor located between the pancreas and the spleen. The presence of an insulinoma was confirmed on the basis of an elevated level of proinsulin at the time of an asymptomatic episode of hypoglycemia. Spleno-pancreatectomy was performed. Histopathological examination revealed a malignant, well-differentiated neuroendocrine malignant tumor.

Anévrisme pulmonaire complètement résolu après un traitement médical au cours de la maladie de Behçet

Pulmonary artery aneurysm in Behcet disease compromises seriously the diagnosis since its fatal rupture is still the major cause of death in this disease. Pulmonary artery aneurysm requires urgent management and several treatments have been proposed, including steroids, immunosuppressive drugs, embolisation and surgery. Herein, we report a patient with Behçets disease in whom multiple pulmonary artery aneurysms were completely resolved after a combined treatment with corticosteroids and azathioprine. Pulmonary artery aneurysms in Behçets disease are reported to indicate poor prognosis and high mortality. Computed tomographic scans of the chest and angiography are the most common diagnostic procedures used in the diagnosis or evaluation of pulmonary artery aneurysm. Immunosuppression is the main therapy for the treatment of a vasculitis.

Mucormycose parotidienne : une nouvelle observation et revue de la littérature

INTRODUCTION Mucormycosis is a rare, devastating, fungal infection, which disproportionately affects non-controlled diabetic patients, notably during ketoacidosis. The authors report the case of cervical mucormycoses with a particularly favorable evolution in diabetic woman. REPORT A 54-year-old woman, type 2 diabetic, had presented a left lateral cervical mass. The diagnosis was confirmed by histological examination. She was treated with Amphotericin B with favorable evolution. CONCLUSION The mucormycose is a rare infection. The treatment is medical and surgical. The prognosis is severe with an overall mortality rate of 40%.

AB0709 Association of tinu, nodal tuberculosis and renal amylosis

Background Tubulo-interstitial nephritis may be caused by drugs, infections or systemic diseases. However, the precise cause and etiology of the disease are unclear. Uveitis is a general terme of the inflammation of the iris and choroid. This ocular disorder is known to be complicated with several systemic disorders such as sarcoîdosis, Behecet’s disease and toxoplasmosis. The association of tubulo-interstitial nephritis and uveitis (TINU) was first described in 1974. Subsequently, Dobrin et al reported two cases of interstitial nephritis complicated with anterior uveitis. Since then, this association has become known as Dubbin’s syndrome. Objectives We present a case of TINU associated with nodal tuberculosis and renal amylosis. Results A 68-year-old woman with 4 months history of nodal tuberculosis diagnosed on histological study of cervical nodal biopsy was referred to our department for painful red eye and decreased vision in both eyes. Physical examination was unremarkable except for the bilateral red eye. Ophtalmological examination objective revealed bilateral non-granulomatous anterior uveitis. Laboratory finding was normal except for proteinuria (1g/24h). Urinary cytobacteriologicalexam showed aseptic leukocyturia. Antinuclear and antineutrophil cytoplasmic antibody test results were negative. Serological tests of infectious were negative. An ophthalmological examination revealed bilateral non-granulomatous anterior uveitis. Abdominal ultrasonography was normal. Histopathological examination of kidney biopsy showed amyloid deposits and tubulo-intersitial nephritis. Diagnosis of TINU was made. The patient was treated with antitubercular drugs. Eight months later, 24h urinary protein gets better and uveitis improved. Conclusions TINU syndrome no longer appears to be so rare, but its mechanism remains unclear. It should be considered as differential diagnosis of unexplained tubule-interstitial nephritis especially in the presence of ocular finding. Disclosure of Interest None Declared

Ectopic Axillary Breast during Systemic Lupus.

Many breast changes may occur in systemic lupus erythematosus. We report a 41-year-old woman with lupus who presented three years after the onset of lupus an ectopic mammary gland confirmed by histological study.

HYPERTENSION IN TAKAYASUʼS ARTERITIS: PP.38.493

Introduction and Purpose: Takayasus arteritis is a rare chronic inflammatory disease, which normally affects the aorta and its main branches, and less often, the pulmonary arteries. Hypertension is common in Takayasus arteritis and may be related to changes of vascular compliance, renal vascular ischaemia with hypereninaemia or increased sensitivity of the carotid body. The aim of our study was to determine the etiologic profile of hypertension in Takayasus disease. Patients and Methods: We carried out a retrospective study of 7 cases of Takayasus arteritis admitted to our department from January 1999 to April 2009. Diagnosis was established according to the classification criteria of the American College of Rheumatology (ACR) in 1990. Results: Seven women were studied; mean age at diagnosis was 34, 57 years. Classification criteria were abnormal arteriography in 100% of cases, diminished brachial pulses in 100%, vascular bruits in 85%, claudication of lower limbs in 57%, difference of blood pressure between arms (>10mmHg) in 57% and age <40 years in 85%. Mean clinical manifestations were malaise in 42%, syncope in 14%, acute cerebrovascular accident in 14%, arthralgia in 28% and visual disorders in 28% of cases. Hypertension was noted in 4 cases (57%). The mean age was 25.5 years (21 – 35 years). In the 4 cases arteriography was abnormal showing renal artery stenosis. Stenosis was bilateral in one case. In one case, the patient was admitted for malignant hypertension and the diagnosis of TA was making. All patients were treated with calcic blokers drugs in association with specific treatment. The chirurgical treatment was angioplasty of the left renal artery in one case and by-pass of the left renal artery in one case. Conclusion: The diagnosis and treatment of hypertension in this disease is imperative, as the commonest causes of death are congestive heart failure, myocardial infarction and strokes, while retinopathy and severe systemic hypertension are predictive of increased mortality.

Renal paraneoplastic vasculitis complicating lung adenocarcinoma.

Renal paraneoplastic vasculitis (RNPV) is rare. It can be revealed by glomerulonephritis, microaneurysms or renal failure. RPNV may precede the onset of the primary tumor, and treatment and prognosis depend on the etiology (primary tumor). A 54-year-old man who had a primary lung adenocarcinoma was admitted for nephrotic syndrome. The investigations revealed RNPV. The patient was treated with corticosteroids at high dose and cyclophosphamide with improvement of the renal condition; however, the patient died from worsening of his pulmonary neoplasia.

Tamponnade cardiaque révélatrice d’un lupus érythémateux systémique

Although pericarditis is the most frequent cardiac involvement in systemic lupus erythematosus (SLE), cardiac tamponade is very rare as an initial manifestation of this disease. We report the case of a 27-year-old patient in whom the diagnosis of SLE was discovered during cardiac tamponade.