L’obstruction urétérale non lithiasique inaugurale d’une maladie de Crohn : une complication rare et méconnue

Noncalculous ureteral obstructions in Crohn??s disease are rare (3% in inflammatory bowel disease). They often are asymptomatic and unidentified. They are secondary to inflammation and fibrosis. Treatment could be medical or surgical. We report the case of a patient with non calculous ureteral obstruction revealing Crohn??s disease.     

Maladie de Still de l’adulte révélée par une myopéricardite

IntroductionAdult Still's disease may present with multiple non-specific clinical manifestations leading to diagnostic difficulties. Presentation as initial myopericarditis is rare but must be known.Case reportWe report a 49-year-old man who presented with the sudden onset of a high fever, arthralgia and myalgia, skin rash, dyspnea and chest pain related to a myopericarditis. Infectious, neoplastic and autoimmune diagnostic work-up was non-contributive. Adult Still's disease was discussed and confirmed by the decrease in the glycosylated fraction of ferritin. Corticosteroids followed by interleukin-1 receptor antagonist (anakinra) therapy allowed a rapid improvement in clinical and biological manifestations.ConclusionAdult Still's disease should be considered in any systemic inflammatory disease without a diagnosis, even with atypical manifestations, especially since it can be life-threatening in the absence of treatment.     

L’invagination intestinale chez l’adulte: mode de révélation rare de la maladie de Crohn

Intussusception is an uncommon cause of intestinal obstruction. It occurs when a proximal segment of bowel telescops into an adjacent distal segment. In adult; it is often associated with an underlying pathology. Approximately 65% of cases are secondary to tumours growth. A few cases of intestinal intussusception; as initial manifestation of Crohn??s disease; have been already reported. This complication leads generally to surgery. But there is no agreement upon the correct surgical treatment, although resection without prior reduction seems to be the best choice.     

Complications neurologiques de l’infection par le virus JC : revue générale

Although human polyomavirus JC (JCV) seroprevalence in the general population is high, its neurological complications are rare and progressive multifocal leukoencephalopathy (PML), a lethal central nervous system (CNS) demyelinating disease, is the most well-known. After an usually asymptomatic primary infection during late childhood, a latent JCV form persists in different sites, notably the kidneys and lymphocytes. Rearrangement of that archetype into the prototypical neurotropic strain can reactivate JCV, thereby enabling its CNS penetration and infection of glial cells. In a context of defective immune defenses (HIV infection, cancer or immunosuppressant therapies) this infection leads to oligodendrocyte death that contributes, via demyelinization, to PML but also, as more recently described, to other CNS complications, e.g., JCV granule cell neuronopathy, meningitis or encephalitis. Clinical manifestations depend on the localization of the lesions. The increasingly widespread use of new immunomodulatory monoclonal antibodies to treat multiple sclerosis and other inflammatory systemic diseases has increased PML frequency in those previously rarely affected entities. Diagnosis relies on magnetic resonance imaging, JCV detection in cerebrospinal fluid and, when necessary, brain histology. PML is often lethal. No specific, evidence-based treatment with clinically relevant efficacy is available. The therapeutic objective is to restore host immune responses to JCV, while avoiding immune-reconstitution inflammatory syndrome.