Vascularite de l’artère hépatique : à propos d’un cas d’atteinte d’organe isolée

Introduction

Vasculitis usually have a systemic involvement. Rare cases of localized vasculitis have been described, but the exclusive involvement of the hepatic artery is exceptional. We report the case of a patient who developed a vasculitis of the right and left hepatic arteries.

Pseudo-polyarthrite rhizomélique satellite d’une leucémie myélomonocytaire chronique

IntroductionMyelodysplasia (MDS) can occur as systemic manifestations such as connective tissue diseases or vasculitis. Rheumatological manifestations are also described in such context. Herein, we report the observation of a patient with chronic myelomonocytic leukemia (CMML) who developed systemic manifestations: polymyalgia rheumatica and pericarditis.Case reportA 78-year-old patient was referred for the exploration of two months history of inflammatory shoulder pain associated with biological inflammatory syndrome. He presented with asthenia, anorexia and loss of 5 kg in one month. He had a three years follow-up for a CMML without any specific treatment. All of the explorations carried out showed a typical polymyalgia rheumatica. A pericardial effusion requiring emergency drainage was synchronously diagnosed. All the symptoms occurred during a worsening of his hematological disease. The rheumatological manifestation was favorable after a short corticosteroid therapy and pericarditis did not recur after 2 years of follow-up.ConclusionIt should be necessary to screen patients for MDS in a context of systemic manifestation, especially in elderly patients with an abnormal blood count (cytopenia, macrocytosis and monocytosis).     

Pancréatite aiguë inaugurale d’une vascularite à IgA de l’adulte : une manifestation inhabituelle

Introduction

IgA vasculitis is a systemic small vessel leukocytoclastic vasculitis characterized by skin purpura, arthritis, abdominal pain and nephritis. Most of the abdominal complications are due to edema and hemorrhage in the small bowel wall, but rarely to acute secondary pancreatitis.

Aortite à cellules géantes compliquée d’amylose AA diagnostiquée grâce aux examens d’imagerie : à propos d’un cas

Introduction

AA amyloidosis is a common but severe complication of many chronic inflammatory processes of infectious, autoimmune, or neoplastic origin. It frequently leads to renal damage, often presenting as a nephrotic syndrome. Giant cell arteritis is a common inflammatory arteritis in elderly people, but rarely complicated by AA amyloidosis.

Pancréatite aiguë liée à l’oméprazole: à propos d’un cas

Proton pump inhibitors are widely used in gastroesophageal reflux and various acid-peptic disorders. They are generally considered safe and have minimal side effects. However, they can cause acute pancreatitis which is a rare effect but can be serious and fatal in some cases.We report a case of acute pancreatitis associated with the first proton pump inhibitor, omeprazole, notified in pharmacovigilance center of Sfax. Elevated pancreatic enzymes and abdominal computed tomography (CT) imaging findings confirmed the diagnosis of pancreatitis. Common causes of pancreatitis were ruled out. A drug side effect was suspected, so the imputability score assessed as plausible. The exact mechanism of this adverse effect is discussed, it seems indirectly due to an increased rate of gastrin secondary to suppression of acid secretion.     

Une coagulopathie intravasculaire disséminée liée à une malformation veineuse

IntroductionCoagulopathy related to venous malformations can be life threatening. This complication is little known and underestimated.Case reportWe report the case of a 52-year-old female patient who presented with a left femoral fracture. She had a pre-existing muscular infiltrating venous malformation of the left hip. During surgery, she developed acute disseminated intravascular coagulation. The latter was probably a consequence of both surgery and localized intravascular coagulation that was unknown before the trauma.ConclusionIt is important to diagnose localized intravascular coagulation in venous malformations, since the risk of disseminated intravascular coagulation can be prevented by anticoagulant therapy.     

Surdité dans l’artérite à cellules géantes : à propos d’une observation

IntroductionHearing loss is a rare manifestation in giant cell arteritis. The different types of deafness are possible with a predominance of sensorineural deafness.Case reportWe report a 75-year-old woman who presented with typical manifestations of giant cell arteritis associated concomitantly with the occurrence of bilateral mixed hearing loss confirmed on the audiogram. Corticosteroids allowed a rapidly favorable clinical and biological outcome. The follow-up audiogram at 3 months was markedly improved and showed a decrease in sensorineural hearing loss and disappearance of conductive hearing loss.ConclusionAny rapid onset deafness in an inflammatory context in the elderly should lead to a search for giant cell arteritis. The diagnosis can be difficult in the absence of other typical manifestations, especially since the biopsy of the temporal artery most often comes back negative. Corticosteroids are usually effective.     

Primo-infection à cytomégalovirus : une cause infectieuse d’infarctus splénique

Introduction

Cytomegalovirus-associated thrombosis has been extensively reported in the medical literature, mainly in immune-compromised patients. However, the association with splenic infarcts has rarely been reported.

La péricardite chronique constrictive,une véritable gangue calcifiée réalisant un goulot d’étranglement médio-ventriculaire : à propos d’un cas

A 30-year-old woman consulted for a predominantly right-sided global heart failure chart that had been evolving for about 3 months. Its antecedents include a concept of poorly treated pleuropulmonary tuberculosis at the age of 8 years. Lateral chest X-ray, transthoracic echocardiography and thoracic CT showed ventricular ring calcification with mid-ventricular compression with apical ballooning. The diagnosis of chronic mid-ventricular constrictive pericarditis of tuberculosis etiology was retained. The patient was put on diuretic treatment and the immediate evolution is favorable with a regression of the signs of congestion. Surgical decortication has been indicated.     

Unité d’attente d’hospitalisation : une organisation simple et une place pour les internistes pour améliorer la filière d’hospitalisation non programmée à partir des urgences

IntroductionThe adult emergency department at Rouen University hospital (CHU) welcomes over 100.000 patients per year. In order to streamline unscheduled hospital admissions from the emergency room (ER), a 20-bed pre-hospitalization unit and a centralized bed management system (bed manager, bed manager software, dedicated beds) have been put into place.Patients and methodsEmergency admissions have increased by (+ 3.5% between 2017 and 2018) with 20% direct hospitalization from the ER to other conventional units (2/3 in medicine, 1/3 in surgery). In 2018, 3450 patients, of which 54% aged over 75 years have been admitted in the pre-hospitalization unit with an average length of stay of 1.3 ± 1.4 days: 35.4% stayed less than 24 hours and 34.8% more than 48 hours of which 5.2% stated more than 4 days, 132 patients (3.8%) died, 805 patients (23.3%) were discharged at home, 220 (6.4%) transferred to another facility, and 2287 (66.3%) were secondarily hospitalized in another hospital unit: more than 9 times out of 10 in a medicine unit (internal medicine 30%, geriatrics 27.9%, respiratory medicine 12.2%). This unscheduled emergency hospitalization allowed a daily hospitalization of 50 short stay inpatients beds. It has to be noted that the number of available inpatient beds clearly decreases during the week-ends. The main pathologies were respiratory infections (14.2%), heart diseases (9.7%), metabolic disorders (3.9%), and urinary tract infections (13.6%).ConclusionThis pre-hospitalization unit associated with a centralized bed management system has clearly improved the unscheduled hospital admissions, in particular concerning the emergency medical sector. The lack of inpatient beds at the week-end and the management of epidemic periods still remain a challenge that has to be taken up.