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).     

Tuberculose de la vésicule biliaire: à propos d’un cas et revue de la littérature

Tuberculosis of gall bladder is rare, even in our country known for being an endemic area. The positive diagnosis is still based on histological examination. The authors report a case of peritoneal tuberculosis spread to the gall bladder, discovery during laparoscopic cholecystectomy. The Study material consisted of a gall bladder fixed in the formol at ten percent. Examination in optical microscopy, after inclusion out of paraffin and coloring with hematein eosin, made it possible to carry the diagnosis.     

Maladie coeliaque et hépatite auto-immune de type 2 : rapport d’un cas et revue de la littérature

Abnormal liver function tests are frequently observed in celiac disease, sometimes indicating the concomittent presence of auto-immune hepatitis (HAI), a documented association well in agreement with the immunological pathogenesis of both conditions. We hereby report the case of a 47 years old man with celiac disease revealed by diarrhoea and weight loss in whom the presence of abnormal LFTs as well as the positivity of ANA and SLA led to the diagnosis of autoimmune hepatitis. The outcome was favorable one year after the initiation of a gluten-free diet and the administration of oral corticosteroids and azathioprine.     

Botulisme : à propos d’un cas et revue de la littérature

IntroductionBotulism is a rare syndrome resulting from the action of a neurotoxin produced by Clostridium botulinum, that it is potentially life threatening if diagnosis is delayed.Case reportWe report a 26-year-old woman who presented an acute onset of bilateral cranial neuropathies associated with an anticholinergic syndrome in the absence fever leading to consider and confirm the diagnosis of botulism. At the end of follow-up, 7 weeks later, the outcome was favorable with an almost complete neurologic recovery.ConclusionAlthough botulism is uncommon, better awareness of its manifestations and high clinical suspicion should shorten diagnostic delay that makes the use of specific antitoxin ineffective. An acute onset of a bilateral oculomotor palsy, a fixed pupillary dilation and descending weakness in the absence of fever is typical of botulism. Outcome is usually favorable with a slow but full neurological recovery.     

Une métastase vésicale révélant une linite gastrique : à propos d’un cas et revue de la littérature

Secondary tumors of the bladder are rare, they represent less than 2% of all bladder neoplasms [1]. Most reported cases conform to autopsy series [2].Frequent primitives are the colon, prostate, rectum and cervix. In such cases, the bladder is affected by direct extension, in particular in advanced stage with peritoneal scattering. The vesical metastases of the gastric cancers are secondary to hematogenous spread of tumor cells. Brought back in the literature by some sporadic cases, there were seven cases of adenocarcinoma with cells signet ring [1]. We report the eighth case of bladder metastasis of gastric linitis which has the distinction to be revealing.     

Syndrome de Lemierre inversé : à propos d’un cas et revue de la littérature

IntroductionLemierre's syndrome is defined as an oropharyngeal infection due to Fusobacterium necrophorum, associated with septic thrombophlebitis of the internal jugular vein. The uncommon pelvic variant of the syndrome is a rare condition, poorly described in literature.Case reportWe report a case of gynecological Lemierre's syndrome in a 19-year-old woman after a first sexual intercourse, who presented acute respiratory failure, left internal iliac vein thrombosis with pulmonary embolism, in the setting of salpingitis and F. necrophorum bacteriemia.ConclusionGynecological Lemierre's syndrome is a rare and unrecognized condition, which could be lethal. Early recognition of the disorder enables initiation of appropriate antibiotic therapy for 4 to 6 weeks, and discussion of anticoagulant therapy which indications are not yet well defined.     

L’hépatoblastome de l’adulte : à propos d’un cas avec revue de la littérature

Introduction

Hepatoblastoma in adults is extremely rare and the prognosis is much worse than the mixed hepatoblastoma of childhood. Only a very few cases have been reported in adults. We report the unusual case of epithelial hepatoblastoma in a 22 year old female patient.

Case report

A 22 year-old female with no history of liver disease was referred to our hospital with a 6 month history of right upper abdominal pain. Physical examination and liver chemistry test were normal. There was no evidence of liver cirrhosis. Awell demarcated solid mass of 11 cm in diameter was detected in the liver by abdominal ultrasound, CT scan and magnetic resonance imaging. Echo-guided biopsies of liver tumor and liver were performed. Histological findings were consistent with the diagnosis of foetal hepatoblastoma with an extensive fibrosis of non tumorous liver. At surgical exploration a large hepatic mass was detected occupying the entire right liver and the surrounding parenchyma appeared as cirrhotic. A right trisegmentectomy VI, VII, VIII was performed with healthy resection margin. Following the operation, the patient has been well and free of recurrence for 22 months.

Conclusion

Hepatoblastoma in adults has an aggressive presentation and a poor prognosis compared than childhood patients. Current treatments for the tumor include surgery and chemotherapy and surgical resection is the cornerstone of treatment for adult patients with hepatoblastoma.     

Analbuminémie congénitale compliquée d’un syndrome coronarien aigu récidivant : à propos d’un cas et revue de la littérature

Congenital analbuminemia (CAA) is a very rare disorder with an estimated prevalence of less than one in one million. This anomaly can be lethal at birth and in early infancy but it's not very symptomatic in adulthood. The clinical signs are edema, lipodystrophy, fatigue… Hypercholesterolemia is the main biological disorder and it predisposes to cardiovascular complications. The mild symptoms of CAA leads to delay diagnosis. That's why clinical and biological signs of this disorder should be known by both of biologist and clinician to establish an early diagnosis in order to prevent cardiovascular complications. We report a new case of congenital analbuminemia complicated by recurrent acute coronary artery disease in 34-year-old man. This complication has been reported only once according to the register of analbuminemia cases.     

Quel bilan devant une haemolacria ? À propos d’un cas et revue de la littérature

IntroductionHemolacria is a rare hemorrhagic syndrome characterized by bloody tears. The most common etiologies are inflammation, infection or laceration. However, other rarer diseases may also cause this clinical manifestation.Case reportWe describe the case of a 14-year-old male patient hospitalized for hemolacria. A history of von Willebrand disease was present in his family, diagnosed in his mother and sister, but absent in our patient. A vitamin C dosage was obtained in our patient and revealed scurvy consecutive to malnutrition. After having excluded other bleeding symptoms like bruises we retained vitamin C deficiency as the etiology of the hemorrhagic syndrome.ConclusionBloody tears are a rare clinical manifestation and the etiology may be difficult to determine. Bloody tears are a rare clinical manifestation of hemorrhagic syndrome. To determine the underlying etiology, screening should consider all possible causes including the rarest.     

Infarctus cérébral et tuberculose : rapport d'un cas et analyse de la littérature

IntroductionAlthough tuberculous meningitis is an uncommon presentation of tuberculosis, it still remains one of the deadliest forms of this disease. In this context, the occurrence of a cerebral infarct is an aggravating factor.ObservationA 48-year-old Asian man presented himself in the emergency room for dysarthria and dysphagia of progressive onset. Cerebral CT showed a recent ischemic defect of the right internal capsule. Lumbar puncture showed meningitis with low sugar levels. Pulmonary micronodules on the thoracic CT suggested tuberculosis, which was confirmed by a broncho-alveolar lavage. Anti-tuberculosis treatment and early corticosteroid resulted in an improvement of the patient's state.ConclusionCerebral infarctions in patients with tuberculous meningitis are events that cannot be underestimated in terms of frequency or severity. Their poor prognosis is partly the result of insufficiently defined management, which combines anti-tuberculosis treatment and early corticosteroid therapy.     

Pseudo-rétinopathie de Purtscher dans le cadre d’une maladie de Still de l’adulte : à propos d’un cas et revue de la littérature

IntroductionPutscher-like retinopathy is a retinal disease that is similar to the syndrome initially described in 1910 by Purtscher, but occurring in a non-traumatic context.Case reportWe describe a case of acute, Putscher-like retinopathy in a 48-year-old woman experiencing adult onset Still's disease. The diagnosis was based on fundus examination and fluorescein angiography. Based on a review of the literature, we discuss the current available data on the pathophysiology of this syndrome and its prognostic significance. The treatment remains controversial.ConclusionWhen visual functional signs appear during adult Still's disease, it is necessary to evoke Putscher-like retinopathy, and to ask for an ophthalmological expertise.     

Bloc atrio-ventriculaire de grade III compliquant une myocardite au décours d’un traitement par anti-PD1 : observation d’un cas et revue de la littérature

IntroductionImmune Checkpoint Inhibitor (ICI) therapy is now a standard of care in numerous cancers with very promising results. Nevertheless, adverse events, and especially immune-related adverse events (irAEs) not reported during clinical trials, are emerging and can be life-threatening.ObservationWe report here a teachable case of a 80 year-old man, of third-degree atrioventricular block consecutive to myocarditis associated with the administration of nivolumab (anti-PD1) monotherapy.ConclusionMyocarditis occurring during ICI treatment is a rare but potentially lethal event. Daily serum troponin level seems to predict ICI-related myocarditis but interpretation could be difficult in the context of associated myositis. Echocardiography and cardiac MRI are also useful but can remain negative. Electrocardiogram is a cornerstone of myocarditis diagnosis. In case of cardiac involvement, continuous heart rhythm monitoring should be performed in addition to the administration of high-dose corticosteroids therapy and the cessation of ICI therapy. Add-on treatments should be discussed with a well-trained multidisciplinary team.