Z. Aydi

Anévrisme pulmonaire complètement résolu après un traitement médical au cours de la maladie de Behçet

Pulmonary artery aneurysm in Behcet disease compromises seriously the diagnosis since its fatal rupture is still the major cause of death in this disease. Pulmonary artery aneurysm requires urgent management and several treatments have been proposed, including steroids, immunosuppressive drugs, embolisation and surgery. Herein, we report a patient with Behçets disease in whom multiple pulmonary artery aneurysms were completely resolved after a combined treatment with corticosteroids and azathioprine. Pulmonary artery aneurysms in Behçets disease are reported to indicate poor prognosis and high mortality. Computed tomographic scans of the chest and angiography are the most common diagnostic procedures used in the diagnosis or evaluation of pulmonary artery aneurysm. Immunosuppression is the main therapy for the treatment of a vasculitis.

Mucormycose parotidienne : une nouvelle observation et revue de la littérature

INTRODUCTION Mucormycosis is a rare, devastating, fungal infection, which disproportionately affects non-controlled diabetic patients, notably during ketoacidosis. The authors report the case of cervical mucormycoses with a particularly favorable evolution in diabetic woman. REPORT A 54-year-old woman, type 2 diabetic, had presented a left lateral cervical mass. The diagnosis was confirmed by histological examination. She was treated with Amphotericin B with favorable evolution. CONCLUSION The mucormycose is a rare infection. The treatment is medical and surgical. The prognosis is severe with an overall mortality rate of 40%.

AB0709 Association of tinu, nodal tuberculosis and renal amylosis

Background Tubulo-interstitial nephritis may be caused by drugs, infections or systemic diseases. However, the precise cause and etiology of the disease are unclear. Uveitis is a general terme of the inflammation of the iris and choroid. This ocular disorder is known to be complicated with several systemic disorders such as sarcoîdosis, Behecet’s disease and toxoplasmosis. The association of tubulo-interstitial nephritis and uveitis (TINU) was first described in 1974. Subsequently, Dobrin et al reported two cases of interstitial nephritis complicated with anterior uveitis. Since then, this association has become known as Dubbin’s syndrome. Objectives We present a case of TINU associated with nodal tuberculosis and renal amylosis. Results A 68-year-old woman with 4 months history of nodal tuberculosis diagnosed on histological study of cervical nodal biopsy was referred to our department for painful red eye and decreased vision in both eyes. Physical examination was unremarkable except for the bilateral red eye. Ophtalmological examination objective revealed bilateral non-granulomatous anterior uveitis. Laboratory finding was normal except for proteinuria (1g/24h). Urinary cytobacteriologicalexam showed aseptic leukocyturia. Antinuclear and antineutrophil cytoplasmic antibody test results were negative. Serological tests of infectious were negative. An ophthalmological examination revealed bilateral non-granulomatous anterior uveitis. Abdominal ultrasonography was normal. Histopathological examination of kidney biopsy showed amyloid deposits and tubulo-intersitial nephritis. Diagnosis of TINU was made. The patient was treated with antitubercular drugs. Eight months later, 24h urinary protein gets better and uveitis improved. Conclusions TINU syndrome no longer appears to be so rare, but its mechanism remains unclear. It should be considered as differential diagnosis of unexplained tubule-interstitial nephritis especially in the presence of ocular finding. Disclosure of Interest None Declared

Ectopic Axillary Breast during Systemic Lupus.

Many breast changes may occur in systemic lupus erythematosus. We report a 41-year-old woman with lupus who presented three years after the onset of lupus an ectopic mammary gland confirmed by histological study.

Cervical Pott's disease revealed by retropharyngeal abcess

montrait une raréfaction des plissements duodénales puis faire é, un t sera [12] Changela K, Safai Haeri N, Krishnaiah M, Reddy M. Plummer-Vinson Syndrome with proximal esophageal web. J Gastrointest Surg 2016;20 (5):1074–5. http://dx.doi.org/10.1007/s11605-015-3051-3055. [13] Bakari G, Benelbarhdadi I, Bahije L, El Feydi Essaid A. Endoscopic treatment of 135 cases of Plummer-Vinson web: a pilot experience. Gastrointestinal Endoscopy 2014;80(4):738–41. Lettres à la rédaction

59 Antiphospholipid syndrome: about 62 cases

Background and aims The antiphospholipid syndrome (SAPL) is an autoimmune and thrombogenic pathology that the diagnosis is based on clinical and biological criteria. It can be isolated (primary SAPL) or associated with another auto-immune disease (secondary SAPL). The purpose of this work is to finalise the epidemiological, clinical, biological, characteristic. Methods We led a retrospective and descriptive study of the patients followed in the service of internal medicine for SAPL between January 1990 and April 2014. Results We brought together 62 cases ( 61 women and 1 man). The average age was 41 years.The peripheral thromboses were observed in 51.6%. The obstetric accidents were found at 26 patients dominated by repeated abortion (35.5%) and fetal death in uterus (16.1%). The cardiac infringement was dominated by valvular disease in 9.6%. The lung demonstrations were represented by a pulmonary embolism in 32.25% and a lung arterial high blood pressure in 19.3%. The neurological infringement was present in 29%. The SAPL was primary in 32% and secondary in 86%. The CAPS was found in 2 cases. The SLE was present in 59.7%. The immunological balance sheet revealed aCL in 77.4%, anti-ß 2GPI in 24.2% and anti-PT in 17.7%. a statistically significant correlation between the obstetric and vascular sign with the presence of aCL. Conclusions The SAPL is an entity among which the knowledge and the understanding are in permanent evolution. It is necessary to think of it in front of any vascular reccurent thrombosis to a young subject.

Particularités épidémiologiques, cliniques et évolutives des pneumopathies interstitielles au cours de la sclérodermie systémique

Pulmonary involvement during systemic sclerosis (SS) is dominated by interstitial lung disease and arterial pulmonary hypertension. It is about a retrospective study analyzing 65 cases of SS over a period of 13 years. We compared cases with and without interstitial lung disease. The diagnosis of SS was retained according to American College of Rheumatology (ACR)/EULAR 2013 criteria. The diagnosis of interstitial lung disease was retained in TDM and EFR. Pulmonary hypertension is defined by a pulmonary arterial pression higher than 25 mmHg. The mean delay of diagnosis of interstitial lung disease and the diagnosis was of 48 months (extremes 0-78 months). The comparison between both groups according to average age of the patients, prevalence of pulmonary hypertension, frequency of Raynaud phenomenon and trophic disorders did not find any significant difference. Lung involvement was associated with an esophageal involvement in 71% of the cases (P=0.059). Antibodies anti-Scl 70 were noted more frequently in patients with interstitial lung disease (79% of the cases, P=0.001). Patients were treated with colchicine and vitamin E. A corticotherapy had been indicated at a single patient. The evolution of SS was marked by the stabilisation of the restrictive syndrome in 71.8% of the cases and a worsening in 25% of the cases. Early and appropriate diagnosis of SS and screening of lung involvement are essential for a early care.

Kaposi’s Sarcoma Presenting as Lymphadenopathy in an Immunocompetent Patient

Introduction Kaposi’s sarcoma (KS) is an angioproliferative disorder first described in 1872 by Moritz Kaposi. Four main clinical presentations of KS have been described: classic, endemic, iatrogenic and epidemic. KS involvement of the lymph nodes is extremely uncommon in the classical variant form, especially if it precedes the skin manifestations. We describe the case of an elderly HIV-negative patient presenting with lymphadenopathy who was found to have KS. Case Report A 67-year-old patient was admitted for exploration of polyadenopathies in the context of a general decline in health. Physical examination revealed an erythematosus left lower limb rash associated with angiomatous nodules and multiple lymphadenopathies. The diagnosis of erysipelas in the left leg was retained and the patient was treated with good evolution of the rash but persistence of the angiomatous nodules and the polyadenopathies. Skin and lymph node biopsies led to a diagnosis of KS. The patient is proposed for polychemotherapy. Conclusion KS must be suspected in lymphadenopathies despite the absence of typical cutaneous signs of the disease and in immunocompetent patients. LEARNING POINTS Involvement of the lymph nodes is extremely uncommon in the classical variant form of Kaposi’s sarcoma (KS). Human herpes virus-8 is an important cofactor in all forms of KS. Pathology and immunohistochemistry are key to diagnosing KS. KS must be suspected in lymphadenopathies without typical cutaneous signs of the disease and in immunocompetent patients.

Wegners Granulomatosis Revealed by Exophthalmos

Ophthalmic involvement is frequent, between 30% and 70% of patient’s present ophthalmic symptoms during the course of Wegner’s granulomatosis. Orbital disease may present initially before the onset of systemic manifestations in only 8 to 16% of patients and it could delay final diagnosis. We report a case illustrates the diagnosis of Wegner’s granulomatosis presenting with proptosis (exophthalmos) of the orbit. Patient was treated with corticosteroid and intravenous cyclophosphamide (CYC) with good response. This case emphasizes early diagnosis and treatment to avoid further complications

AB0935 Clinical Characteristics of Tuberculous Spondylitis: About 13 Cases

Background Osteo-aticular tuberculosis represents 2 to 5% of all tuberculosis. Tuberculous spondylitis arise at any age. Dorsolumbar location is most frequently touched and clinical presentation is not specific. The MRI presents a superior to other radiological exams in the exploration of tuberculous spondylitis. Objectives The purpose of our study is to specify epidemiological, clinical, biological and therapeutic peculiarities of Tuberculous Spondylitis in Tunisian patients. Methods A retrospective and descriptive analysis including patients with tuberculous spondylitis followed in the department of internal medicine during a period of 15 years from January 2000 till January 2015. Tuberculin skin test, imaging techniques, mycobacterium cultures, histopathologic examination, treatment and clinical outcome were reported. Diagnosis was retained in front of positive bacteriological or histopathological exams and/or association of clinico-biological or radiologic arguments with therapeutic proof. Results We identified 13 patients with tuberculous spondylitis. It was about 9 women and 4 men with a middle-age at the time of diagnosis of 53, 4 years with extremes between 13 and 90 years. The mean diagnosis delay was 7,4 months. Main initial symptoms were back pain in 11 cases, mobility limitation in 6 cases and dysphagia in a case. Blood tests showed leukocytisis in a case an elevated C-reactive protein levels in 9 cases. Tuberculin skin test was positive in 7 cases. Bacterial diagnosis was positive in a case. Granuloma with necrosis was noted at the histopathologic examination of the bonedraining biopsy in 3 cases. Radiologic exams contained standard spinal radiographs in 7 cases, Computed tomography scanning in 7 cases and magnetic resonance imaging in 6 cases. The imaging examination showed signs of lytic destruction of vertebral body with vertebral collapse in all cases, and multiple abscesses in 5 cases. Spondylitis was located in thoracic vertebra in 6 cases, lumbar vertebra in 6 cases and cervical vertebra in a case. Other locations of the tuberculosis were noted in 5 cases and were represented by lymph nodes, meningeal, peritoneal, retropharyngeal and urogenital tuberculosis. All the patients were treated by a tuberculosis quadritherapy. A patient received corticosteroids for spine involvement. The median duration of the treatment was of 16 months. The outcome was favourable in all cases with stabilization of the radiological involvement. The mean follow up was of 15,7 months Conclusions Tuberculosis always rages under an endemic mode in developing contries. Inspite of the absence of immunosuppression, tuberculosis spondylitis was associated to other tuberculous locations in 5 cases. The beginning is often insidious with a late diagnosis. The association of clinical, biological and radiological arguments with therapeutic proof allowed to carry the diagnosis. Disclosure of Interest None declared