Y. Cherif

Causes and outcome of hospitalisations in Tunisian patients with systemic lupus erythematosus

Objective To describe the most common reasons of admission of Tunisian patients with systemic lupus erythematosus (SLE) and the outcomes of these hospitalisations. Method The charts of patients with SLE who were hospitalised at our Department of Internal Medicine during a 2-year period from January 2011 to December 2012 were retrospectively reviewed, and the demographic characteristics, clinical and laboratory features, as well as all comorbidities, were collected. Results There were 128 episodes of hospitalisation of 87 patients with SLE. 25 patients (28.7%) were admitted twice or more. The median length of stay for all admissions was 11 days (2–76). The total number of days of hospitalisation was 1896 days, which represent 10.7% of the total number of days of hospitalisation in our department. The most common overall reason for hospitalisation was active SLE (55 events, 43%). In 29 patients, SLE was newly diagnosed during hospitalisation. Other causes of hospitalisation included assessment of the disease, infections (9.4%) and associated autoimmune disease (6.25%). Adverse drug reaction (3.1%) and thromboembolic events (1.25%) were uncommon causes of hospitalisations. There was a significant difference in length of stay between patients admitted with SLE flare and those admitted for non-SLE flare reasons (p<0.01). Four hospitalisations (3%) resulted in death. The principal cause of death was active SLE. Conclusions Hospitalisation of patients with SLE is common in our department. Our study of this North African SLE population confirms the findings of previous studies suggesting that active SLE and infection remain the most common causes of hospitalisation of patients with SLE.

Acute generalized exanthematous pustulosis induced by piroxicam: a case report.

Acute generalized exanthematous pustulosis (AGEP) is a severe adverse cutaneous reaction characterized by an acute episode of sterile pustules over erythematous-edematous skin. The main triggering drugs are antibiotics, mainly beta-lactam and macrolides. Non-steroid anti-inflammatory drugs may rarely be responsible. We describe a case of a woman with AGEP, who presented with generalized pustulosis lesions after the use of piroxicam for renal colic. The diagnosis was confirmed by the clinical and histological correlations and the dermatosis resolved after withdrawal of the drug.

A challenging entity: multiple sclerosis or collagen tissue disorders: A case series of 6 patients

Background: Multiple sclerosis and other demyelinating processes are sometimes difficult to differentiate from the neurological involvement in autoimmune diseases. Distinguishing multiple sclerosis from other lesions due to autoimmune diseases is crucial to avoid unsuitable or delayed treatments. Methods: Charts of 6 patients diagnosed with mimicking multiple sclerosis between 1996 and 2014 were retrospectively assessed. Results: The mean age at diagnosis was 35±7 years. The most commonly neurological manifestation at onset was paraparesis due to transverse myelopathy and uni/bilateral optic neuropathy. All our patients suffered from recurrent episodes of optic neuritis with a mean lag time of 12 months. Other initial presenting neurological manifestations in our patients included ataxic gait and pyramidal syndrome. Systemic symptoms occurred a long time before or after their initial neurological presentation. All patients had numerous T2 hyperintense lesions in the periventricular white matter and spinal cord with contrast enhancement. The antibodies tests revealed the presence of significant amounts of anti-nuclear antibodies. The anti-phospholipid antibodies were negative in all patients. All patients were treated with corticosteroid therapy and neurological features were cleared in all cases. Conclusion: Multiple sclerosis, other myelitis and optic neuritis, are sometimes difficult to differentiate from CNS involvement in autoimmune disease. Indeed, the clinical presentation, immunological profile and MRI lesions may be similar.

A Relapsing Polychondritis and Malignancies: A Case Report and Review of Literature

Some case reports and series presumed a link between malignancy and relapsing polychondritis. The most frequent described neoplasms have been hematological disorders especially myelodysplastic syndromes. Less commonly have also been reported solid neoplasms as colorectal cancer like our patient. We suggest that patients with RP should be monitored more carefully even in remission for early detection of cancer. On admission to our department, physical examination revealed thickening of both external ears with erythema of the auricles with a saddle-nose. Fine rales over both lower lung fields were heard. Ophtalmological examination revealed bilateral anterior uveitis. Computed tomography of the chest disclosed stenosis of the trachea, swelling of cartilages and bilateral main bronchus (Figure 1). All the laboratory data was with the normal range. Antinuclear antibody was negative. Auricle biopsy showed a lymphocytic infiltration around the blood vessels, which is compatible with RP. Given that our patient has recurrent chondritis of auricles, nasal cartilage and the upper respiratory tract, recurrent uveitis, the diagnosis of RP was made and the patient was treated with Prednisone: 30 mg/day for 3 weeks and the dose of prednisone was tapered with no relapse. He was admitted 3 years after for acute rectal bleeding. The pulse rate was 110 per minute, and his blood pressure was 110/70 mmHg. He stated that he lost 10 Kg in weight 2 months before. Besides, he complained of lower abdominal pain and bloody diarrhea.Laboratory studies revealed anemia at 6.9 g/dl, the leukocyte count: 5690/mm3, the platelets count: 423000/mm3. Serum electrolytes, creatinine and liver tests were with the normal range. The stool culture was negative. Tumor markers were checked: PSA were normal but he had marked elevation of CEA, CA19-9 markers of up to 325 ng/ml. The patient was transfused. Abdominal computed tomography revealed a thickness of the descending colon wall, a liver mass on the right lobe and a necrotic adenopathy (Figure 2). Colonoscopy revealed an ulcer formation and bleeding from the sigmoid colon. Colic tumor specimen showed undifferentiated adenocarcinoma. An extended right colectomy was performed. A subsequent chemotherapy was administrated. He was discharged and still receiving Prednisone: 10 mg/day without flare-up of RP. Discussion RP is a rare recurrent inflammatory diseasethat affects cartilaginous tissue, especially the ear, nose and tracheobronchial cartilage [1,3]. Our patient, having recurrent chondritis and chronic uveitis fulfilled the diagnosis criteria of Michet [1] in the absence of evidence of other disease. Introduction Relapsing polychondritis (RP) is an uncommon systemic disease which is characterized by recurrent inflammation of cartilaginous tissues, including the ears, nose, laryngotracheobronchial tree, and peripheral joints. Evidence for a significant RP-cancer association is uncommon [1]. Some case reports and series presumed a link between malignancy and RP. About 85 cases of RP associated with malignancies have been reported in the literature [2]. The most frequent described neoplasms have been hematological disorders especially myelodysplastic syndromes [1]. Less commonly solid neoplasms have also been reported [2]. Although it has been noted that RP may occur with colic cancer, colorectal cancer associated with RP remains scarce. We present a patient with chronic RP that developed acolorectal cancer 12 years later and we reviewed all cases reported in literature. Case Report A 56-year-old man was admitted in June 2012 to our department of Internal Medicine complaining of progressive weakness and dyspnae for about 3 weeks. His medical history was noteworthy of recurrent uveitis. He had hoarseness and intermittent breathlessness for greater than 9 years. At that time, there were no fever, night sweating. He was admitted repeatedly in the department of Otorhinolaryngology. A bronchoscopy showed a subglottic stenosis. The patient experienced further dyspnea, so emergency tracheostomy was performed. The patient was treated with inhaled corticosteroids and betaagonists for bronchial asthma, without a significant improvement thereafter. He reported recurrent swelling and tenderness of both ears. Check for updates

Late-onset primary antiphospholipid syndrome in the elderly: a report of seven cases

We describe the clinical profile of elderly with primary antiphospholipid syndrome (APS).