W. Bono

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.

Visceral leishmaniasis in 26 HIV-negative adults

BackgroundVisceral leishmaniasis is a notifiable parasitic disease that had increased in incidence in our region on the past few years. It is common in children. In adults, it occurs more on a background of immunodeficiency, and frequently with incomplete clinical manifestations, making the diagnosis complicated.FindingsThe aim of our study is to reveal different features of visceral leishmaniasis in adults, through the analysis of its epidemiological, clinical and biological parameters, in a group of 26 patients. No one was infected with HIV or under immunosuppressive therapy Clinical presentation was generally conservative, but there was few differences in adults compared to children, concerning both the clinical symptoms and the laboratory parameters. Diagnosis was provided by direct examination of bone marrow smears in 24 cases (sensitivity 92%), and anti-leishmanial serology in the others.ConclusionWe should think to the diagnosis of VL even if the patient is not known immunocompromised, and even if the clinical is incomplete, to avoid a delay of care which can lead to serious complications.

Primary bone lymphoma presenting as a monoarthritis.

Primary bone lymphomas (PBL) are uncommon malignancies that account for approximately 3% of malignant bone tumors. We report a case of primary non-Hodgkin lymphoma (NHL) of the right elbow presenting as a monoarthritis and review clinical and radiologic presentations and therapeutic strategies of these uncommon diseases. A 68-year-old man, was admitted for 4 months history of intense pain and swelling of the right elbow, without any other associated signs. Physical examination showed elbow inflammation, redness, and swelling; the patient was unable to fully extend this joint. Pain occurred with active and passive motion of the elbow in any direction. The general physical examination was normal and there were no fever. Laboratory investigations showed an erythrocyte sedimentation rate at 25 mm, C-reactive protein at 40 mg/L, and the complete blood cell count was normal. Radiographic examinations revealed osteolytic lesions of the right ulna and elbow joint (Fig. 1). Axial computed tomography showed sequestrum formation with a soft tissue mass. Histologic bone examination confirmed the diagnosis of diffuse large B cell lymphoma. The synovium was reported to show nonspecific inflammation. Physical and radiologic studies showed no evidence of lymphadenopathy, organomegaly, or other mass lesions in the body. There was no peripheral lymphocytosis or bone marrow involvement. The diagnosis of stage IE primary NHL of the right elbow was confirmed, and the patient received chemotherapy consisting of cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP). Consolidation radiotherapy and surgery treatment will be discussed later.

Lymphome T/NK nasal: à propos de deux cas rares

NK/T-cell lymphoma is a severe and rare disorder in Africa and in Europe. Treatment is based on radiotherapy and chemotherapy. We here report two cases of elderly patients aged 55 years and 52 years, respectively, with bilateral nasal obstruction associated with purulent rhinorrhea. Clinical examination showed cleft palate. Diagnosis was made on the basis of immunohistochemical examination of biopsies. Both patients underwent CHOEP chemotherapy followed by radiotherapy. Nasal NK/T-cell lymphoma is an aggressive type of non-Hodgkins lymphoma with specific clinicopathologic features. Combining chemotherapy with radiotherapy in patients with advanced stage of the disease does not seem to improve survival compared with radiotherapy alone, which is the treatment of choice especially for localized stages. Nasal NK/T-cell lymphoma is rare. Diagnosis is based on immunohistochemical examination. Treatment includes chemotherapy and radiotherapy. This lymphoma has a poor overall prognosis, even with appropriate therapy.

Spondylarthrite ankylosante et maladie de Still: un lien physiopathologique ou une simple association?

Ankylosing spondylitis is a chronic inflammatory rheumatism; it is part of the group of spondyloarthrites. General signs such as fever and weight loss are of little importance. Adult Stills disease is a rare systemic condition, a diagnosis of exclusion commonly characterized by high hectic fever, rash, arthritis and various systemic manifestations. Few cases of ankylosing spondylitis associated with adult Stills disease have been described in the literature. We here report the case of a 31-year old patient followed up for ankylosing spondylitis presenting with fever which had lasted for a long time and clinico-biological signs compatible with adult Stills disease. A possible pathophysiologic link between the two diseases may be suggested, even if their simultaneous occurrence has been rarely reported in the literature.

Effet thérapeutique des eaux minérales thermales sur la gonarthrose : revue systématique des essais randomisés et contrôlés

ots cles : Revue systematique ; Arthrose ; Genou ; Eaux minerales hermales ; Balneotherapie ; Balneologie bjectif.– Evaluer l’effet therapeutique, a court et a long termes des eaux mineales thermales sur les patients atteints de gonarthrose. ethodes.– Nous avons realise une recherche bibliographique en janvier 2008 ur les bases de donnees « Pubmed », « Cochrane » et « Amed » utilisant les ots : balneotherapy, balneology et mineral water combines avec knee et steoarthritis. La qualite methodologique des etudes avait ete evaluee en utilisant ne echelle standard. esultats.– La recherche bibliographique avait identifie 226 etudes ; 9 essais andomisees et controlees avaient ete retenus selon les criteres d’inclusion et ’exclusion etablis pour ce travail. L’echantillon final comprenait 493 patients ui avaient poursuivi les etudes jusqu’a la fin. La duree du suivi de ces patients llait de 10 a 24 semaines [15,33± 5,56]. L’ensemble des etudes avaient montre ne amelioration des criteres de jugement par rapport a l’etat initial des patients EVA douleur, indice de Womac, indice de Lequesne, diminution de la consomation des AINS et/ou des antalgiques). Dans certains travaux, la difference ’etait pas significative comparee au groupe temoin. Aucun effet indesirable rave en rapport avec le traitement thermal n’avait ete rapporte. onclusion.– Il semble probable que les eaux minerales thermales ont un effet herapeutique, a court et a long terme, sur les patients atteints de gonarthrose. ais nous pensons que d’autres essais controles et randomises, avec des effectifs lus importants et selon une methodologie plus rigoureuse sont necessaires pour eterminer la place reelle de ce moyen therapeutique non pharmacologique dans a gonarthrose, sachant qu’il serait difficile de realiser des essais cliniques en ouble aveugle.