T. Amezyane

Mycotic iliac aneurysm associated with Burkholderia pseudomallei.

A 60-year-old African man, without any significant medical history or immunodeficiency, was admitted to the hospital with a one-week history of fever, jaundice, and abdominal pain. On admission, he was febrile (temperature 40 8C) and tachypneic. Physical examination revealed crepitant rales in the lung bases, abdominal sensibility, with a maximum of pain, and a vascular souffle in the left flank quadrant. Laboratory studies showed a white blood cell count of 23.6 10 cells/l, increased C-reactive protein (190 mg/l), and cholestasis with hyperbilirubinemia (114 mmol/l). Abdominal ultrasonographic examination and magnetic resonance imaging (MRI)–angiography showed a saccular aneurysm in the left common iliac artery, measuring 55 mm in transversal diameter (Figure 1). The diagnosis of mycotic aneurysm was strongly suspected. Resection of the aneurysm with implementation of an aorto-iliac allograft was realized within 24 h. Blood and arterial cultures grew an unusual Gram-negative bacillus, Burkholderia pseudomallei (Figure 2), the cause of vascular, lung and liver melioidosis in our case. The patient’s clinical course was favorable under parenteral antimicrobial therapy (imipenem

Les antagonistes de l’interleukine-6 (tocilizumab) dans la maladie de still réfractaire de l’adulte

INTRODUCTION The pathogenesis of Stills disease is best elucidated for the better recognition of the involvement of Many pro-inflammatory cytokines in the genesis of this condition. Publications have reported the contribution beneficial for certain biotherapeutics, such as anti-TNFa, the anti-CD20 or antagonists of interleukine1 (IL-1) tested successfully in the treatment of systemic Juvenile idiopathic arthritis (Stills disease the child), the tocilizumab is a humanized monoclonal antibody directed against the receptor for interleukin-6 and is beginning to be reported as effective in some refractory cases of Stills disease in adults. PATIENTS We report two young patients with Stills disease in adults with refractory early and prolonged remission after the first infusion tocilizumab. CONCLUSION The tocilizumab can be used in patients MSA with refractory after failure or intolerance conventional treatments.

Hypercalcémie humorale révélant un lymphome malin non hodgkinien

INTRODUCTION Hypercalcemia is a rare complication of non-Hodgkin lymphoma. Usually, hypercalcemia occurs late in the disease course, except for high-grade lymphoma. Most often hypercalcemia is related to excessive level of circulating PTH-rP or sometimes, 1,25(OH)2D3. Concomitant high plasmatic concentration of PTH-rP and 1,25(OH)2D3 is uncommon. EXEGESIS We report the case of a 82-year-old man who presented with abdominal pain and weight loss, leading to the diagnosis of diffuse large-B-cell lymphoma (high-grade lymphoma) associated with symptomatic hypercalcemia (3.21mmol/l). PTH-rP and 1,25(OH)2D3 plasmatic levels were high. Calcium concentration was normalized with glucocorticoids and sequential chemotherapy. CONCLUSION This case report confirms that hypercalcemia, as consequence of excessive plasmatic level of PTH-rP secreted by tumoral cells, can occur early in the course of high-grade lymphoma. Glucocorticoids and chemotherapy are the best treatment options.

Un abcès rétropharyngé

Une femme de 16 ans, sans antécédents pathologiques, était dmise pour une exploration d’une tuméfaction latérocervicale roite, avec dysphagie haute, évoluant depuis un mois et assoiée à une fébricule et un amaigrissement non chiffré. L’examen de a région cervicale retrouvait une adénopathie jugulocarotidienne aute droite, douloureuse, inflammatoire, de consistance molle et esurant 3 cm de grand axe. L’examen endobuccal mettait en évience un bombement de la paroi postérieure du pharynx, ainsi que eux adénopathies sous-maxillaires gauches. Le reste de l’examen tait sans particularité. Le scanner cervical (Fig. 1) montrait une collection de densité iquidienne, mesurant 25 × 18 × 50 mm, de siège rétropharyngé, ’étendant en haut jusqu’au plancher du cavum qui était refoulé en aut et arrivant en bas au niveau du C3. L’adénopathie jugulocarotiienne sus-décrite paraissait à centre nécrotique. Sur l’IRM (Fig. 2), ette collection ovalaire et bien limitée était en hyposignal T1, en ypersignal T2 et en contact en arrière avec la carotide primitive roite, et rétrécissant la lumière du rhinopharynx. La radiographie es poumons et le scanner thoraco-abominopelvien étaient sans nomalies. Il n’avait pas d’anémie, ni de syndrome inflammatoire iologique ni de cytolyse hépatique.

RACAND syndrome associated with primary biliary cirrhosis

The acronym RACAND means the association of Raynauds phenomenon, anticentromere antibodies and digital necrosis without digital sclerosis. It is a rare syndrome recently individualised. The association with primary biliary cirrhosis has never been previously reported, and leads to discuss its nosology. A 57-year-old woman with a history of Raynauds phenomenon, presented with recurrent episodes of fingers and toes necrosis. Clinical examination did not evidence digital sclerosis. Anticentromere antibody titer was high. There was no oesophageal or lung involvement. A liver biopsy performed because of moderate increase in liver enzymes showed histological lesions of primary biliary cirrhosis. Treatment with iloprost, platelet aggregation inhibitors and anticalcic drugs could not avoid amputation of several toes. It is possible that anticentromere antibodies are directly toxic to vascular endothelial cells and result in a diffuse or localized vasculopathy. The association with primary biliary cirrhosis is in favour of autoimmune condition of both vascular and ductular endothelial cells.

Antioxidants status in type 2 diabetic patients in Morocco

BACKGROUND/AIM Type 2 diabetes is a heterogeneous and multifactorial metabolic disorder with some relationship to oxidative stress (OS). Since no studies were conducted in the Moroccan population, this clinical investigation aimed at evaluating the antioxidants status in Moroccan patients with type 2 diabetes. MATERIALS AND METHODS Blood samples of 60 type 2 diabetic patients and 40 healthy controls subjects were analyzed for determination of glycemia, hemoglobin, CRP, glycated hemoglobin, lipid parameters, malondialdehyde (MDA), vitamins E and C, copper (Cu), zinc (Zn), and selenium (Se). RESULTS CRP and triglycerides were higher in the diabetic group while high-density lipoprotein levels were significantly lower compared to the control group. Plasma MDA, Cu concentrations, and Cu/Zn ratio were found to be higher in diabetic patients compared to healthy subjects, while vitamin E, Zn, and Se concentrations were lower compared to the control group. No significant difference was found in vitamin C levels between the two groups. Plasma HbA1c was positively correlated to MDA levels. CONCLUSION This study shows that antioxidant status is impaired in diabetics compared to healthy controls.

Serum vitamin D and vitamin D receptor gene polymorphism in Moroccan patients with systemic lupus erythematosus

Background: Vitamin D plays an important role in the immunomodulation and could be involved in the development of autoimmune diseases such as systemic lupus erythematous (SLE). The study of the polymorphism of the Vitamin D Receptor (VDR) gene may be of interest in explaining the pathophysiology of SLE. Methods: In this study, we aimed to examine the characteristics of VDR gene BsmI polymorphism for the first time in Moroccan patients with SLE and their relationship with clinical manifestations of the disease. We also measured the serum level of 25-hyroxyvitamin D 3 to assess its relation to such polymorphism. Results: The study included 66 SLE patients and 91 healthy controls. Our results showed that there were no differences observed in VDR genotypes and allelic distribution within the two groups. Both groups were in Hardy-Weinberg equilibrium, with no significant P values for the observed and expected genotype frequencies. 25-hyroxyvitamin D3 serum levels were the same in the two groups. Conclusions: Based on the results of the present study. We cannot verify any association between VDR gene BsmI polymorphism and SLE. This polymorphism could not be regarded as a genetic marker of the SLE. A larger study examining BsmI and other VDR gene polymorphisms is needed.

Cas cliniqueSyndrome RACAND associé à une cirrhose biliaire primitiveRACAND syndrome associated with primary biliary cirrhosis

The acronym RACAND means the association of Raynauds phenomenon, anticentromere antibodies and digital necrosis without digital sclerosis. It is a rare syndrome recently individualised. The association with primary biliary cirrhosis has never been previously reported, and leads to discuss its nosology. A 57-year-old woman with a history of Raynauds phenomenon, presented with recurrent episodes of fingers and toes necrosis. Clinical examination did not evidence digital sclerosis. Anticentromere antibody titer was high. There was no oesophageal or lung involvement. A liver biopsy performed because of moderate increase in liver enzymes showed histological lesions of primary biliary cirrhosis. Treatment with iloprost, platelet aggregation inhibitors and anticalcic drugs could not avoid amputation of several toes. It is possible that anticentromere antibodies are directly toxic to vascular endothelial cells and result in a diffuse or localized vasculopathy. The association with primary biliary cirrhosis is in favour of autoimmune condition of both vascular and ductular endothelial cells.

Syndrome RACAND associé à une cirrhose biliaire primitive

The acronym RACAND means the association of Raynauds phenomenon, anticentromere antibodies and digital necrosis without digital sclerosis. It is a rare syndrome recently individualised. The association with primary biliary cirrhosis has never been previously reported, and leads to discuss its nosology. A 57-year-old woman with a history of Raynauds phenomenon, presented with recurrent episodes of fingers and toes necrosis. Clinical examination did not evidence digital sclerosis. Anticentromere antibody titer was high. There was no oesophageal or lung involvement. A liver biopsy performed because of moderate increase in liver enzymes showed histological lesions of primary biliary cirrhosis. Treatment with iloprost, platelet aggregation inhibitors and anticalcic drugs could not avoid amputation of several toes. It is possible that anticentromere antibodies are directly toxic to vascular endothelial cells and result in a diffuse or localized vasculopathy. The association with primary biliary cirrhosis is in favour of autoimmune condition of both vascular and ductular endothelial cells.