Leila Souabni

Normal plasma FGF23 levels kinetic in tenofovir-related hypophosphatemic osteomalacia in an HIV-infected patient with von Recklinghausen disease

The antiretroviral agent tenofovir can cause hypophosphatemic osteomalacia due to renal phosphate wasting. The potential role for Fibroblast Growth Factor 23 (FGF23), a phosphaturic hormone is unknown. We evaluated FGF23 plasma concentrations in an HIV-positive patient with neurofibromatosis in whom hypophosphatemia developed during tenofovir therapy. This patient presented with diffuse pain, hypophosphatemia and tubular dysfunction with inadequate phosphate reabsorption. The full recovery after tenofovir discontinuation indicates that the hypophosphatemia was related to tenofovir and not to von Recklinghausen disease. Our data argue against a role for FGF23 in tenofovir-induced hypophosphatemia nor in the regulation of hypophosphatemia in this situation.

Possible macrophage activation syndrome following initiation of adalimumab in a patient with adult-onset still’s disease

Macrophage activation syndrome (MAS) has been rarely reported in the course of adult-onset Stills disease (AOSD) and in the majority of cases, it was triggered by an infection. Here, we report, to our knowledge, the first case of MAS occurring after adalimumab treatment initiation and not triggered by an infection. A 26-yearold woman with classical features of AOSD developed persistent fever, severe bicytopenia associated with extreme hyperferritinemia, hyponatremia and abnormal liver function tow months after the initiation of adalimumab treatment. The diagnosis of MAS was made without histological proof. The patient was treated with methylprednisolone pulse therapy and her condition improved. During the disease course, extensive studies could not identify any viral infection or other known underlying etiology for the reactive MAS. The adalimumab was incriminated in this complication. Currently, the patient is in remission on tocilizumab and low-dose prednisolone.

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.

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.

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 …