R. Salem

Hypersensitivity Syndrome Induced by Anticonvulsants: Possible Cross-Reactivity Between Carbamazepine and Lamotrigine

A 14‐year‐old male presents with erythroderma and fever 44 days after carbamazepine intake. Laboratory exams show eosinophilia and elevated liver enzymes, and thoracic imaging reveals interstitial pneumonitis. All symptoms disappear after carbamazepine withdrawal. A patch test to carbamazepine performed 6 weeks after recovery is positive. About 8 months later, the patient exhibits the same clinical and biological picture 52 days after lamotrigine intake. Lamotrigine is stopped and all symptoms disappear. A patch test to LMG is positive. This case illustrates a possible cross‐reactivity between carbamazepine and lamotrigine, which are aromatic and nonaromatic anticonvulsants, respectively.

Co-existing sarcoidosis and Takayasu arteritis: report of a case

Introduction Takayasu arteritis (TA) is a chronic vasculitis of unknown origin, affecting mainly the aorta and its main branches. As a result of the inflammation, stenosis, occlusion or dilatation of the involved vessels may occur and cause a wide range of symptoms. It has been described in association with various auto-immune disorders (mainly inflammatory digestive tract diseases). However, only few cases of TA associated with sarcoidosis have been reported, raising the question of an association by chance. Case report We report a case of a 34 year-old woman, with one year history of sarcoidosis, who presented with asymmetric high hypertension revealing inflammatory humeral, axillary and subclavian arteritis related to TA, successfully treated by steroid and immunosuppressive therapy(MethotrexateR). Conclusion TA and sarcoidosis may be related, rising the hypothesis that TA or Takayasu arteritis-like granulomatous vasculitis may be, in fact, a complication of sarcoidosis.

Lipoblastoma: a rare lesion in the differential diagnosis of childhood mediastinal tumors.

Lipoblastoma is a rare, benign, fatty tissue tumor that occurs in childhood. The location of this tumor in the mediastinum and extension to the chest wall is uncommon. We describe a 12-month-old male infant with a mediastinal lipoblastoma discovered because of a chest wall swelling. Computed tomography showed the deep component and fatty content of the lesion suggestive of the diagnosis. Total excision of the mass was carried out. The histologic examination of the lesion confirmed the diagnosis of lipoblastoma. Mediastinal lipoblastoma should be considered among the possible diagnoses of a fatty mediastinal tumor in childhood.

Congenital pancreatic cyst with Ivemark II syndrome: a rare case

An infant with congenital pancreatic cyst with Ivemark II syndrome is reported because it is a rare association. The infant had associated situs inversus, asplenia, and complex congenital heart disease. The pancreatic cyst was successfully managed by cystoduodenostomy because of connection to the biliary tract. The infant succumbed as a result of heart failure at age 2 months. Prognosis depends on the presence of life-threatening malformations.

Le kyste hydatique rétrovésical chez l'enfant : à propos de trois cas

Resume La localisation retrovesicale du kyste hydatique chez l’enfant est rare meme dans les zones d’endemie. A travers l’exposition de trois cas de kyste hydatique retrovesical, les auteurs rappellent les signes cliniques et radiologiques de cette pathologie en insistant sur les difficultes diagnostiques et therapeutiques.

Pericarditis as an initial symptom in Takayasu arteritis

Takayasu arteritis (TA) is a chronic inflammatory vasculitis with unknown etiology, affecting the large and medium sized arteries with a striking predilection for aorta and its major branches. Because of the non specific initial clinical presentation, the disease remains undiagnosed for a long period of time. Cardiac manifestations in TA are rarely reported in the literature. They determine the disease prognosis. Pericardial effusion was rarely reported in TA, and is exceptionally the first manifestation. We report a case, of TA presented initially with acute pericardial effusion. A 18yearold female was admitted to the hospital with chest pain and dyspnea. The 2-dimensional echocardiography showed moderate pericardial effusion measuring 1.1 cm anteriorly and 1.2 cm posteriorly. Laboratory finding showed elevated erythrocyte sedimentation rate (ESR; 120 mm/hr) and C-reactive protein (CRP; 6 mg/dl), hemoglobin 11.2 g/dl and platelet count 413.000/ml. She received non steroidal antiinflammatory drugs (NSAID) for 2 months under the impression of acute viral pericarditis. Her symptoms did not improve and the echocardiography revealed the persistence of pericardial effusion. The nature of pericardial fluid was an exudate. Protein counts were 5600 mg/dl. Lactic dehydrogenase was 538 UI/L and WBC counts was 204/μl, with 15% lymphocytes, 10% neutrophil and 75% others. Gram and AFB stains of pericardial fluid showed no organisms and the cytology was negative for malignancy. Pericardial biopsy revealed neither evidence of tuberculosis nor signs of malignancy. Viral and bacterial serology was negatives (B and C hepatitis, Epstein Barr Virus, Herpes Simplex Virus, tuberculosis). On physical examination, there were pulse differences and carotid tenderness, with asymmetric blood pressure (110/60 mm Hg in the left arm and 135/80 mm Hg in the right arm) and bilateral systolic subclavian and carotid murmurs. The electrocardiogram showed low voltage in the precordial leads.

Escherichia coli osteomyelitis of the ischium in an adult.

Osteomyelites, bone infections of a hematogenous origin, are rare in the pelvis (2.3%) and are extremely rare in the ischium. Ischiatic osteomyelitis is usually found in children and adolescents, but has rarely been described in adults. The clinical presentation varies and the diagnosis is based on magnetic resonance imaging (MRI). The most frequently isolated germ is the staphylococcus, while Escherichia coli has been found in a few cases. We report a case of osteomyelitis from E. coli in a 46-year-old woman revealed by persistent fever. The point of entry was a septicemia from gastrointestinal origin, related to colon polyps. The clinical picture was also complicated by an antiphospholipid antibody syndrome (superior mesenteric vein and splenomesenteric branch thrombosis). The course was favorable thanks to appropriate antibiotic treatment and surgical debridment of the infection.

Brain MRI image segmentation in view of tumor detection: application to multiple sclerosis

Multiple Sclerosis (MS) is an inflammatory and demyelization disease that causes the disorder of the central nervous system. Magnetic resonance imaging (MRI) becomes the most important means for a better understanding of the disease. A variety of methods to segment these lesions are available to make the lesions detection less fastidious. So, we use a robust algorithm on EM algorithm that proposes an original detection scheme for outliers. The results obtained are very satisfactory.

Imaging Features of Behçet’s Disease

Behcet’s disease is a chronic vasculitis clinically characterized by relapsing orogenital aphthosis associated with a large multisystemic spectrum of clinical manifestations. Imaging is essentially helpful to evaluate vascular involvement and to monitor post-therapeutic evolution of cardiovascular, neurological, respiratory, and digestive involvements. Familiarity with the various and specific imaging findings of this disease is fundamental to make an early detection and guide the optimal care of patients.

Pelvic abscess complicating sigmoid colon perforation by migrating intrauterine device: A case report and review of the literature

Highlights • Intrauterine devices (IUD) are effective, safe, and widely used contraceptive devices. Their use is about 14.7% in the developing countries and 8.9% in developed ones.• The perforation of the uterus by the IUD is a relatively rare complication whose incidence is estimated between 1.3 and 1.6 per 1000 insertions, but the consequences can be very serious.• Ectopic migration of IUD with involvement of adjacent organs can cause catastrophic complications such as gastrointestinal perforation.• Ideal treatment of IUD migration remains controversial.