Actinomycose pelvienne pseudotumorale : à propos de deux cas

Introduction

Pelvic actinomycosis is a rare suppurative disease that should be included in the differential diagnosis of gynecological cancers.

Case reports

We report two women aged 40 and 41 years with pelvic tumor-like actinomycosis. Physical examination disclosed a pelvic mass in both cases. CT-scan showed annexial infiltrative tumor in both cases with liver metastasis and peritoneal carcinosis in one case each. Surgical procedure consisted in right annexectomy in one case and peritoneal biopsy in the other. Pathologic diagnosis was diagnostic of actinomycosis. Both patients were treated by penicillin G 20 million IU/day during two weeks and then by amoxicilline 3 g/day per day during six months. Clinical outcome showed significant improvement in both cases with complete regression of hepatic and pelvic lesions on CT-scan in one case.

Conclusion

Pelvic actinomycosis is a rare suppurative disorder, commonly associated with a long term wearing of intra-uterine device. Diagnosis is difficult, often delayed and pelvic actinomycosis could mimic gynaecologic neoplasia.     

Lymphomes spléniques de la zone marginale et auto-immunité : à propos de six cas

Introduction

Autoimmune manifestations are common in splenic marginal zone lymphoma (SMZL) and are sometimes the presenting feature of the disease. Autoimmune cytopenia (anemia, thrombocytopenia) are the most frequently reported autoimmune conditions. However, other immunological manifestations may be associated with SMZL.

Méthodes

We report a retrospective case series of six patients with SMZL associated with autoimmunity.

Results

Auto-immune manifestations were the presenting feature of lymphoma in four cases. Auto-immune manifestations included auto-immune cytopenia in three cases (two hemolytic anemia and one pancytopenia), thyroiditis in two cases, systemic lupus and Still's disease in one case each. Antinuclear antibodies were detected with a titre of 1/250 in three cases, and with a titre of 1/32,000 in the patient with systemic lupus. Testing for DNA antibodies was negative in all cases. Two patients had a circulating lupus anticoagulant, with portal venous thrombosis following splenectomy in one case. One patient had hypogammaglobulinemia. A monoclonal gammopathy was detected in three patients. All patients had spleen enlargement. Immunophenotyping of blood peripheral lymphocyte was typical in five out of the six cases. Bone marrow was infiltrated in five out of the six cases. Diagnosis was obtained by the combination of immunophenotyping and bone marrow histopathology in five cases, and by splenic histopathology in the remaining case. Hepatitis C virus serology was negative in all patient.

Conclusion

Autoimmune disease as systemic lupus or Still's disease may be associated with SMZL before its tumoral manifestations are evident. In this mode of presentation, spleen enlargement, hypogammaglobulinemia, monoclonal gammopathy, and multiple autoimmune diseases, should alert the physician.     

Syndrome de Gleich : à propos d’un cas

The Gleich's syndrome is a rare disease that causes recurrent angioedema associated with major eosinophilia with good response to corticosteroids. We describe a 53-year-old man who presented with a Gleich's syndrome with a 6-year follow-up and propose a literature review. This case emphazises the favourable prognosis of this disease. In case of poor tolerance of corticosteroids, mepolizumab could be tested.     

Thrombopénie immunoallergique à la rifampicine : à propos d'un cas

Rifampicin can induce toxic and hypersensitivity reactions. However, immediate hypersensitivity (IgE-mediated) reactions are rare. In contrast, other types of reactions, among which are the immunoallergic thrombocytopenias, are not exceptional. We report the case of a 73 year-old man with pleural tuberculosis who reported having hemorrhagic and purpuric symptoms five hours after beginning treatment with rifampicin, isoniazid and pyrazinamide. A diagnosis of rifampicin-induced immunoallergic thrombocytopenia was made, based on extrinsic and intrinsic etiological criteria, despite a negative specific serum antibody assay and a borderline positive rifampicin skin prick test. No previous treatment with rifampicin was reported by the patient, except for prior prolonged self-administration of eye drops that may have contained rifampicin. This adverse effect cannot be explained by an immediate type hypersensitivity reaction, but probably resulted from a type II or III hypersensitivity reaction, as suggested in the literature. The short interval between the beginning of treatment and the onset of symptoms may have been a consequence of earlier sensitization to rifampicin-containing ophthalmic drops. In conclusion, we report a case of rifampicin-induced immunoallergic thrombocytopenia. This case illustrates the limits of diagnostic tests for drug allergy, especially for type II and III hypersensitivity reactions. It also raises the question of the sensitizing potential of drugs administered locally, as well as the question of the necessity of informing physicians and patients of this possibility.