S. Turki

Polymorphisms of Toll-like receptor-4 and CD14 in systemic lupus erythematosus and rheumatoid arthritis.

BackgroundToll-like receptor 4 (TLR4) and its co-receptor CD14 play a major role in innate immunity by recognizing PAMPs and signal the activation of adaptive responses. These receptors can recognize endogenous ligands mainly auto-antigens. In addition, TLR4 (Asp299Gly) and CD14 (C/T -159) polymorphisms (SNPs) may modify qualitatively and/or quantitatively their expression. Therefore, they could be implied in autoimmune diseases and can influence both susceptibility and severity of systemic lupus erythematosus (SLE) and rheumatoid arthritis (RA).Patients and methodsTLR4 (Asp299Gly) and CD14 (C/T -159) SNPs were genotyped using polymerase chain reaction (PCR)-RFLP in 127 SLE patients, 100 RA patients, and 114 healthy controls matched in age and gender.ResultsCD14*T allele was significantly more frequent in SLE patients (0.456) comparatively to controls (0.355), p = 0.02 OR (95% CI) = 1.53 [1.04-2.24]. In RA patients, the higher frequency of CD14*T allele (0.405) failed to reach significance, p = 0.28. Investigation of the TLR4 (Asp299Gly) SNP showed no significant association neither with SLE nor with RA.Analysis of these SNPs according to clinical and biological features showed a significant higher frequency of arthritis in SLE patients carrying CD14*T/T genotype (92%) comparatively to those with C/C and C/T genotypes (72.5%), p = 0.04. Moreover, SLE patients carrying CD14*T/T/TLR4*A/A haplotype had significantly more arthritis (91.3%) than the rest of SLE group (73%), p = 0,044 and confirmed by multivariable analysis after adjustment according to age and gender, p = 0.01.ConclusionThe CD14 (-159)*T allele seems to be associated with susceptibility to SLE and arthritis occurrence.

Périartérite noueuse dans sa forme intra abdominale : aspects angiographiques

Resume Objectifs La periarterite noueuse (PAN) est une angeite necrosante touchant les arteres musculaires de petit et de moyen calibre. Le but de ce travail est d’evaluer l’apport de l’imagerie en particulier l’angiographie dans la forme intra-abdominale de la PAN dans une serie de 17 patients colliges sur une periode de 20 ans dans un service de medecine interne. Materiels et Methodes Nous avons revu retrospectivement le tableau clinique et les donnees de l’imagerie de 17 patients porteurs d’une PAN dans sa forme intra-abdominale. Tous les patients etaient explores par une arteriographie numerisee renale et/ou digestive avec un cliche d’UIV post-angiographique. Trois patients avaient beneficie d’un examen TDM abdominal. Tous les patients ont eu une biopsie musculaire. Une patiente avait beneficie d’une biopsie chirurgicale au niveau de la vesicule biliaire. Resultats L’arteriographie etait concluante dans 12 cas en montrant des micro-anevrismes au niveau des arteres de petit et de moyen calibre. La TDM avait objective un hematome sous capsulaire spontane du rein dans deux cas et une pancreatite aigue dans un cas. Conclusion L’atteinte des arteres digestives et renales est tres frequente dans la PAN. La mise en evidence de micro-anevrismes permet de poser le diagnostic meme si la biopsie est negative.

Systemic lupus erythematosus and celiac disease.

Joint Bone Spine - In Press.Proof corrected by the author Available online since vendredi 30 septembre 2011

Kidney Transplantation During Autoimmune Diseases

Herein, we report the results of kidney transplantation in 9 of 376 patients who underwent kidney transplantation at our center between 1986 and 2007 because of chronic renal failure associated with autoimmune disease. Four of the 9 patients had systemic lupus erythematosus, 3 had Wegener granulomatosis, and 2 had Goodpasture syndrome. Six patients received organs from living donors, and 3 received cadaver organs. Infections were frequent and included cytomegalovirus and urinary tract infection in most cases. There was no difference in occurrence of metabolic and cardiovascular complications in our study patients compared with other transplant recipients. Incidence of allograft loss (n = 1) was similar to that in our entire transplantation population, with an overall rate of 2.9%. We conclude that kidney transplantation is a reasonable therapeutic option in patients with autoimmune disease with end-stage renal disease because of good graft and patient survival compared with kidney recipients without autoimmune diseases.

La fibrose rétropéritonéale

Resume Objectif Nous avons etudie les caracteristiques cliniques, therapeutiques et evolutives de la fibrose retroperitoneale. Methodes Nous avons analyse les observations de fibrose retroperitoneale diagnostiquees entre 1980 et 2002 dans notre hopital, a partir des resumes de 15 patients ayant une fibrose retroperitoneale (FRP). La surveillance therapeutique a ete fondee sur la biologie et la radiologie. Resultats Il s’agissait de 11 hommes et de 4 femmes dont l’âge moyen etait de 44,5 ans avec des extremes de 28 a 64 ans. Tous les malades avaient des douleurs essentiellement lombaires et abdominales. Un syndrome inflammatoire existait dans tous les cas et une insuffisance renale dans 11 cas. Les explorations radiologiques ont montre une hydronephrose uni ou bilaterale dans 14 cas et la plaque de fibrose dans 13 cas. Le traitement a ete constitue de corticoides seuls dans 9 cas, de chirurgie seule dans 3 cas et de chirurgie associee a la corticotherapie dans 3 cas. Dix rechutes a raison de 1 a 5 ont ete observees chez 4 malades apres arret des corticoides. Apres un delai moyen de suivi de 36 mois (18 j a 11 ans) 1 deces a ete observe, 12 patients avaient une fonction renale normale et 2 malades ont garde une insuffisance renale moderee. Conclusion Nous avons confirme la rarete de la fibrose retroperitoneale, la difficulte de son diagnostic, la frequence de la douleur, du syndrome inflammatoire et de l’insuffisance renale. Les corticoides sont efficaces et un suivi regulier est necessaire.

Septic sacroiliitis revealing an infectious endocarditis

We report the case of a 43-year-old man admitted for right hip ache and fever. Physical examination revealed a fever, an ache at the manipulation of the sacroiliac joint and a limitation of abduction and external rotation of the right hip. There was no murmur in cardiac auscultation. No anomaly was found at the conventional radiographs of the sacroiliac joint, while the pelvic MRI confirmed a right sacroiliitis. A sacroiliac puncture with a study of synovial fluid demonstrated the presence of Streptococcus viridans. The blood culture revealed the same germ. Transthoracic and transoesophageal echocardiography confirmed infectious endocarditis with vegetation in the mitral valve. He received penicillin G and gentamicin relayed by pristinamycin because of an allergy to penicillin G with a total duration of treatment of 40 days. His symptoms and the laboratory and radiological tests abnormalities resolved totally with no recurrence.

A Case of Type 1 Autoimmune Pancreatitis (AIP), a Form of IgG4-Related Disease (IgG4-RD)

Patient: Male, 70 Final Diagnosis: IgG4 RD Symptoms: Jaundice Medication: — Clinical Procedure: — Specialty: Gastroenterology and Hepatology Objective: Rare disease Background: Type 1 autoimmune pancreatitis (AIP), also known as lymphoplasmacytic sclerosing pancreatitis (LPSP), is a rare cause of chronic pancreatitis, characterized by a fibro-inflammatory process. However, patients with AIP may have a good response to corticosteroid therapy. We describe a Tunisian patient with AIP that was confirmed to be an IgG4-related disease (IgG4-RD). Case Report: We describe a case of a 70-year-old man who was admitted to hospital for obstructive jaundice and abdominal pain. Serum liver function tests were abnormal and upper abdominal computed tomography (CT) imaging showed diffuse pancreatic swelling and strictures of the main pancreatic duct without any focal lesion. Pancreatico-biliary magnetic resonance imaging (MRI) showed a thickened rim surrounding the pancreatic duct Serum IgG4 levels were elevated, resulting in a diagnosis of IgG4-related AIP. The patient showed a good clinical, biochemical, and radiological response following steroid therapy in combination with azathioprine. Conclusions: The diagnostic workup of IgG4-RD is complex and usually requires a combination of clinical examination, imaging, and serological analysis. As this case report has demonstrated, IgG4-RD should be considered in patients who present with pancreatitis or AIP, because of the favorable response to steroid therapy, particularly when treatment is initiated early.

A neural network based on time series for spatiotemporal relationships prediction

The study of spatial objects and their evolution is a complex process. Most of the techniques used in this field do not consider the evolution of spatiotemporal relationships. The present paper proposes a new approach for the prediction of the future behaviour of spatiotemporal relationships based on spatiotemporal association rules. Such rules demonstrate the evolution of spatial objects and the influence of the spatial distribution of adjacent-areas relationships. We use a predictive neural network based on a nonlinear time series technique to generate spatiotemporal predictive rules. The learning examples correspond to spatiotemporal association rules and the results are in the form of spatiotemporal predictive rules assessing the future spatiotemporal relationships. These relationships can be used to inform about upcoming risks. We conduct an experimentation using a time series of satellite images, describing Megrine zone in the southern coast of Tunis (Tunisia). As a final result, we obtain spatiotemporal predictive rules describing the spatiotemporal relationships evolution between anterior and future dates. A comparison between the predicted values and the ground truth shows good correspondence rates varying between 78% and 90%.

Epidemiology and outcome of articular complications in adult onset still’s disease

The adult onset Stills disease is a rare inflammatory pathology of unknown pathogeny. The clinical features are variable. The diagnosis is difficult since exclusion of infectious, systemic and tumoral pathologies should be done. The articular complications are frequent and can be revelatory of this pathology. The articular prognosis depends on the diagnosis delay and the treatment efficiency. Our study aims to analyze different aspects of articular manifestations complicating adult onset Still disease to define epidemiological, clinical and evolving characteristics of these complications. It was a cross-sectional study concerning 18 cases of adult onset Still disease diagnosed from 1990 to 2014 in the internal medicine A department of Charles Nicolle Hospital in Tunis, meeting Yamaguchi criteria. We identified clinical, radiological, evolving and therapeutic profile of the articular manifestations occurred in these patients. There were 11 women and 7 men. The average age was 27 years. The arthralgias were reported in all cases; while, the arthritis interested thirteen patients. A hand deformation was found in four patients. A wrist ankylosis was noted in one case and a flexion elbow in one patient. The Standard articular radiographs were normal in ten cases. The treatment associated essentially non-steroidal anti-inflammatory and/or corticosteroids and/or methotrexate. Concerning the evolving profile, the monocyclic form was present in 25% of the cases, the intermittent form in 40% and the chronic articular form in 35% of our patients. The adult onset Stills disease is rare and heterogeneous. The articular disturbances are frequent and have various outcomes.

A pulmonary aneurysm: don't forget Hughes-Stovin syndrome

Hughes-Stovin syndrome is a scarce pathology associating pulmonary artery aneurysms and deep venous thrombosis and affecting commonly the young patient. A 27 year old man was hospitalised for recurrent hemoptysis and a left femoral vein thrombosis. Besides, he had oral ulcers. The ophthalmological examination was normal. Laboratory studies found a microcytic hypochromic anemia (hemoglobin: 11g/dl).The coagulation tests, the renal and the hepatic functions were normal. Besides, the bacteriological examination in search for mycobacterium tuberculosis and the immunological investigations were negative. The chest radiograph revealed a left surrounded para-hilar opacity. The CT of the chest confirmed the presence of a giant aneurysm in the left lower lobe pulmonary artery of 90 mm/72 mm, partially thrombosed, occupying the quasi-totality of the left pulmonary field. All abnormalities of hemostasis, a tumoral origin, a vasculitis like Behcets disease and an infectious etiology were eliminated in our patient. Therefore, Hughes-Stovin syndrome was our diagnosis. The patient was put on oral corticosteroid (1 mg/kg/day), and intravenous cyclophosphamide; the steroids were subsequently tapered and withdrawn after 6 months until reaching a minimal dose of 10 mg/day. There has been no recurrence of deep venous thrombosis or hemoptysis. There was no evidence of enlargement of the pulmonary artery aneurysms on chest CT scan control. He was programmed for an embolization because of the giant aspect of the aneurysm.