Sarcome granulocytaire : à propos de 2 cas et revue de la littérature

Introduction

Myeloid sarcomas are uncommon proliferations of immature myeloid cells occurring in any extramedullary organ. We report here two cases of myeloid sarcomas in patients with, respectively, a polycythemia vera and a myelodysplastic syndrome.

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.     

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.

Infection fulminante fatale à Capnocytophaga canimorsus : à propos d’un cas et revue de la littérature

Introduction

Capnocytophaga canimorsus is a Gram-negative bacterium present in normal dogs and cats mouths. It can be responsible for septic shocks after dog or cat bite, especially in asplenic patients.

Actinomycose atypique révélée par des lésions cutanées à distance : à propos d’un cas et revue de la littérature

IntroductionDermatological manifestations of actinomycosis are classical, most often related to Actinomyces israelii. In most of the cases, they occur near to the primary focus, and in the cervicofacial area. Systemic dissemination with cutaneous distant metastasis is rare, most often related to A. israelii, too. We report an original case of upper limb actinomycosis associated with an oral localisation and due to an unusual bacteria.Case reportA 49-year-old man was referred to the Department of dermatology for a skin lesion of the left hand and wrist. Biopsies revealed actinomycosis related to A. meyeri. Dental primary focus was identified and treated. Although the patient was lost sight of, dental eradication and prolonged antibiotics therapy allowed cutaneous improvement.DiscussionWe report an atypical case of cutaneous actinomycosis due to an Actinomyces meyeri dental infection occurring in an immunocompetent, smoking adult, with poor oral hygiene. The literature review revealed only 4 well-documented cases of cutaneous A. meyeri infections distant to dental primary focus. All of patients were males, immunocompetent, with a history of poor oral hygiene. The prognosis is favourable with adequate treatment (antibiotic therapy and surgical treatment to eradicate dental infectious entry points).     

Les bisalbuminémies : à propos d’un cas

Introduction

Bisalbuminemias consist in rare qualitative modifications of several aspects in the albumin pattern. Bisalbuminemias, most of which are not pathological, can be observed using capillary electrophoresis.

La thrombose veineuse portale de l’adulte: à propos de 28 cas

Aim

To study clinical, epidemiological character, aetiology and treatment of portal thrombosis in Morocco.

Material and method

A retrospective study of 28 cases of portal thrombosis at Gastroenterology Department of University Hospital Mohamed-VI Marrakech for a period of four years between January 2004 and December 2008.

Results

Twenty women and eight men of the average age of 40 were studied. The clinical symptoms included acute abdominal pain in 11 cases, a mesenteric infarct in one case, an assessment of portal hypertension in 14 patients and ascitis in two cases. The abdominal ultrasound combined with Doppler in patients showed portal thrombosis in 15 cases and portal cavernoma in 13 cases. Local cause was found in 21 patients. The assessment to find a prothrombotic disorder was required in 15 patients, but it was carried out in only five patients due to lack of means. The assessment results were deficiency in C and S proteins in three cases, a protein S deficiency in one case and an AC antiphospholipide syndrome in one case. Twelve patients in whom thrombosis was considered as acute according to clinical and radiological evidences were given anticoagulant treatment for six months, while eight patients received anticoagulant treatment for life. The prognosis was good for all medicated patients except one patient who died due to a mesenteric infarct.

Discussion

Portal thrombosis is the main cause of portal vein occlusion outside malignancy obstructive tumor. It’s a rare pathology with prevalence between 0.05 and 0.5% according to series; in our study, it represents 1% of hospitalised patients. Because of the low specificity of clinical presentation dominated by abdominal pain, it is usually discovered in late stage after the occurrence of portal cavernome. Abdominal ultrasounds accompanied by Doppler is an effective exam, which confirms the diagnosis in 85% of patients. Angiotomography gives more precisions. Many factors are often responsive of portal thrombosis. Etiological investigation is required to make treatment.

Conclusion

Portal thrombosis is a frequent pathology in our context. Its therapeutic care is difficult because of the high cost of its etiological analysis and its occurrence in particular patients.     

Diagnostic de la lymphogranulomatose vénérienne : à propos d’une série de 5 cas

Introduction

Lymphogranuloma venereum (LG) is a sexually transmitted infection (STI) caused by Chlamydia trachomatis L serovar.

L’allergie aux Rosacées chez l’enfant : à propos de vingt-deux cas

Rosaceae allergy is the fourth most frequent food allergy in Spanish children whereas it is rare in French children. The aim of the present study was to analyse the natural history of Rosaceae allergy in French children living in the Mediterranean area and to underline its specificities. We reviewed the case records of 22 children. The diagnosis of Rosaceae allergy was based on the clinical history and confirmed by skin prick tests with fresh foods and with commercial extracts and the Pharmacia CAP-RAST. Sensitivity to birch was also assessed by prick tests. The patients were divided into two groups: 12 children who were sensitised to Rosaceae and to birch pollen and eight who were sensitised to Roseacea only. The diagnostic value of prick tests with commercial extracts for Roseacea allergy was poor in both of these groups. The birch-negative group had become allergic to peaches first, and all of these children were sensitive to extracts of the cooked native fruits that were responsible for their clinical reactivity. Severe allergic reactions had occurred more frequently in this group. Prick tests with commercial extracts were positive only in this group. In contrast, the birch-positive group was more frequently allergic to apples, and the oral allergy syndrome was common among them. The median level of sensitisation to fresh fruits was also higher in this group. French children living in the Mediterranean appear to have a specific Rosaceae sensitisation profile: 60% of them have a Northern Europe profile (birch–apple allergy) and 40% of them have a Spanish–Italian profile (lipid-transfer protein allergy).     

Mégaduodénum: à propos de deux cas

Megaduodenum is a rare condition. It may be idiopathic or secondary to visceral myopathy or neuropathy. The clinical manifestations vary from total latency to severe pseudo-obstruction. Recurrent urinary infections are common. The diagnosis is easily made by radiology and manometry revealing a motor disorder of the esophagus, small intestine, and anorectum. Surgical treatment poses specific technical problems related to the presence of biliarypancreatic confluence and head of the pancreas. The aim of this study is to describe the clinical manifestations; radiological and manometric abnormalities observed during megaduodenum and discuss therapeutic modalities. We report two patients: the first a 27-year-old man, operated for upper gastrointestinal stricture in another center where a large gastric dilatation was observed with a permeable pylorus. A lateral side anastomosis was performed between the duodenum and the second jejunal loop. The patient was readmitted to our department 4 years later for recurrence of the same symptoms. The former intraoperative duodenojejunal anastomosis was permeable. A total duodenal diversion was performed. The second patient a 22-year-old man, had a brother who is dead in the first year.. This case is associated with ophthalmologic disorders, facial dysmorphism, and a Barrett’s esophagus. The patient received a total duodenal diversion with satisfactory results, the blood karyotype showed no chromosomal abnormalities.