Latifa Tahiri

Ankylosing spondylitis associated with Sweet’s syndrome: a case report

IntroductionSweet’s syndrome is an acute neutrophilic dermatosis characterized by a diffuse dermal infiltrate of mature neutrophils. In most cases, it occurs as an isolated phenomenon (idiopathic Sweet’s syndrome) but it can be drug induced or associated with a variety of underlying diseases such as infections, neoplasms, and chronic inflammatory diseases. The association between Sweet’s syndrome and ankylosing spondylitis is rare. Only a few cases have been reported in the literature. We report a new case in which we describe an outbreak of acute neutrophilic dermatosis revealing ankylosing spondylitis.Case presentationA 33-year-old Moroccan man presented with large-joint polyarthralgia, inflammatory pain in his buttocks and lower lumbar spine, fever and skin lesions. On examination, the patient had a low-grade fever, six tender but not swollen joints, limitation of motion of the lumbar spine, and painful erythematous maculopapules over his face, neck, and hands. Laboratory tests showed hyperleukocytosis, and elevated erythrocyte sedimentation rate and C-reactive protein. The immunological tests and infectious disease markers were negative. Investigations for an underlying neoplastic disease remained negative. Magnetic resonance imaging showed a bilateral sacroiliitis. Skin biopsy findings were consistent with Sweet’s syndrome. The diagnosis of Sweet’s syndrome associated with ankylosing spondylitis was established. Nonsteroid anti-inflammatory drugs were started and the patient showed rapid clinical and biological improvement.ConclusionThree observations of the association between Sweet’s syndrome and spondylarthropathy have been reported in the literature. The cause of this association remains unclear. Some hypotheses have been developed, but further studies are needed to confirm or refute them.

Bilateral pigmented villonodular synovitis of the knee

Joint Bone Spine - In Press.Proof corrected by the author Available online since mercredi 13 octobre 2010

Diffuse uremic tumoral calcinosis in a patient on long-term hemodialysis.

Tumoral calcinosis is an uncommon and severe complication of hemodialysis therapy. The most important pathogenic factor involved in uremic tumoral calcinosis is an increase in calcium-phosphorus product, not necessarily related to hyperparathyroidism. We report here a patient on hemodialysis who presented with increasing multifocal and uncommon sites of massive calcifications. The patient was examined, and a diagnosis of uremic tumor calcinosis was made. The patient was treated with the noncalcemic phosphate binder sevelamer, a strict diet, multiple hemodialysis sessions per week, and a low calcium dialysate, with improvement on biological findings a decrease in the volume of some tumors on his fingers and a global stable disease. Some nodes in hands and feet disappeared; in other sites, their diameter was reduced, and the largest nodule decreased from 5- to 2-cm diameter.

Proximal symphalangism and premature ovarian failure.

Proximal symphalangism is a rare autosomal dominant affection responsible for multiple joint ankylosis, it results from NOG gene mutation whose locus is on 17q21-22. This gene may be involved in secretory functions of glands such as ovarian function. Premature ovarian failure is idiopathic in 80% of cases but may be secondary to multiple etiologies including genetic. We report the case of a patient with proximal symphalangism and premature ovarian failure, and we discuss the possibility of genetic relationship between the two anomalies.

Antisynthetases syndrome associated with right heart failure

Cardiac involvement is a complication of end stage polymyositis with left heart insufficiency reported to be the most frequent manifestation. We here describe an unusual clinical presentation of antisynthetases syndrome, beginning with right-sided cardiomyopathy associated with right heart failure. A 26 year-old Caucasian male experienced a 6-month clinical course of polyarthritis, fever, sweats, and myalgia. Laboratory studies showed elevated C reactive protein, elevated sedimentation rate, and myolysis associated with anti SSA and anti JO1 antibodies. Electromyography showed a myopathic pattern. Muscle biopsy confirmed the diagnosis of polymyositis. Chest X ray, chest scan, and cardiac echography were normal. One week after hospital admission, the patient developed acute right heart insufficiency, and magnetic resonance imaging showed a right ventricular myocarditis with myocardial inflammatory thickening. Treatment with corticosteroids rapidly improved both symptoms and biological abnormalities.

Valproate-induced systemic lupus erythematous: A case report.

homogène et modérée (Savini et al., 2011). Il n’existe pas à ce jour de traitement de référence, plusieurs options thérapeutiques peuvent être discutées. La décompression chirurgicale permet un résultat immédiat ainsi qu’un diagnostic anatomopathologique, elle est préférentiellement indiquée chez les patients paraplégiques (Salehi et al., 2004 ; Dragean et al., 2011). Lorsque le déficit moteur est incomplet, on privilégie un traitement médical. Le tissu hématopoı̈étique étant radiosensible, la radiothérapie se révèle efficace (Salehi et al., 2004 ; Malik et al., 2007). Les doses utilisées sont faibles et ne comportent habituellement pas de risque de myélopathie postradique. L’hypertransfusion sanguine corrige l’anémie et l’hypersécrétion d’erithropoı̈étine, de cette façon les foyers ectopiques restent silencieux et/ou régressent (Salehi et al., 2004). Ce choix thérapeutique est d’autant plus efficace qu’il est associé à un agent cytoréducteur comme l’hydroxyurée (Bruneteau et al., 2000).

Rheumatic complications of long term treatment with hemodialysis

Patients undergoing hemodialysis therapy develop serious osteoarticular diseases. The treatment is based on prevention. The aim of our study is to determine the frequency and the associated factors to the rheumatic manifestations in hemodialysis patients. A cross-sectional study was conducted, including all hemodialysed patients in our dialysis unit. Information was obtained from patients’ symptoms, examination findings, and biological and radiological signs. The frequency of symptoms was 70% in our patients. It was proportional to the duration of hemodialysis and number of hemodialysis sessions per week. Early transplantation is of course a plausible solution, but other therapies such as improved dialysis must be considered.

Adult presentation of diastematomyelia: A case report

Joint Bone Spine - In Press.Proof corrected by the author Available online since samedi 14 mai 2011

Gonococcal polyarthritis with sternoclavicular joint involvement in pregnant woman: a case report.

Pregnancy is one of conditions that increase the risk of gonococcal arthritis which result from blood dissemination of neisseria gonorrhoeae. A 20-year-old africain female patient (in the second trimester of pregnancy), was admitted to hospital because of fever, asymmetric joint swollen affecting the hands, wrists, left ankle, and right sternoclavicular joint. Laboratory findings (erythrocyte sedimentation rate was 117 mm in first hour, The serum C-reactive protein level was 152 mg/L) the gram stain of genital sample was positif of neisseria gonorrhoeae and trichomonas vaginalis. With antibiotics, outcome of pregnancy was timely and uneventful. Patients should be educated about the mode of transmission of gonorrhea. Sexual partners should also be treated to prevent dissemination and gonococcal re-infection.

Celiac disease causing severe osteomalacia: an association still present in Morocco!

Celiac disease (CD), a malabsorption syndrome caused by hypersensitivity to gliadin fraction of gluten. CD can manifest with classic symptoms; however, significant myopathy and multiple fractures are rarely the predominant presentation of untreated celiac disease. Osteomalacia complicating celiac disease had become more and more rare. We describe here a case of osteomalacia secondary to a longstanding untreated celiac disease. This patient complained about progressive bone and muscular pain, weakness, fractures and skeletal deformities. Radiological and laboratory findings were all in favor of severe osteomalacia. Improvement of patients weakness and laboratory abnormalities was obvious after treatment with gluten free diet, vitamin D, calcium and iron. This case affirms that chronic untreated celiac disease, can lead to an important bone loss and irreversible complications like skeletal deformities.