La paralysie faciale périphérique a frigore

Idiopathic peripheral facial palsy, also named Bell's palsy, is the most common cause of peripheral facial palsy in adults. Although it is considered as a benign condition, its social and psychological impact can be dramatic, especially in the case of incomplete recovery. The main pathophysiological hypothesis is the reactivation of HSV 1 virus in the geniculate ganglia, leading to nerve edema and its compression through the petrosal bone. Patients experience an acute (less than 24 hours) motor deficit involving ipsilateral muscles of the upper and lower face and reaching its peak within the first three days. Frequently, symptoms are preceded or accompanied by retro-auricular pain and/or ipsilateral face numbness. Diagnosis is usually clinical but one should look for negative signs to eliminate central facial palsy or peripheral facial palsy secondary to infectious, neoplastic or autoimmune diseases. About 75% of the patients will experience spontaneous full recovery, this rate can be improved with oral corticotherapy when introduced within the first 72 hours. To date, no benefit has been demonstrated by adding an antiviral treatment. Hemifacial spasms (involuntary muscles contractions of the hemiface) or syncinesia (involuntary muscles contractions elicited by voluntary ones, due to aberrant reinnervation) may complicate the disease's course. Electroneuromyography can be useful at different stages: it can first reveal the early conduction bloc, then estimate the axonal loss, then bring evidence of the reinnervation process and, lastly, help for the diagnosis of complications.     

Carcinose péritonéale secondaire à un adénocarcinome de la prostate: une entité rare

The authors report a case of peritoneal carcinomatosis deriving from a prostatic primary tumour in an 81 year old patient, who had undergone prostatectomy three years earlier. There was haemorrhagic ascites with high protein content. This contained many adenocarcinomatous cells identical to those of the primary tumour. Prostate specific antigen was raised. Histology of the original operative specimen had revealed adenocarcinoma. All of these findings suggested a diagnosis of peritoneal carcinomatosis secondary to a prostatic primary. This case enables us to emphasise the known rarity of this locus for metastases in prostatic adenocarcinoma.     

Syndrome platypnée-orthodéoxie secondaire à une pneumopathie : à propos de deux cas

IntroductionThe platypnea-orthodeoxia syndrome is a rare situation characterized by the appearance of dyspnea and/or hypoxemia during the transition to orthostatism.ObservationsWe report the case of two patients, who presented with a platypnea-orthodeoxia syndrome following pneumocystis pneumonia and COVID-19, revealing an intracardiac communication with a right-left shunt on contrast ultrasound.ConclusionThis syndrome can be detected easily at the bedside with positional maneuvers and the shunt demonstrated by a hyperoxia test. Non-reversible situations may require correction of the anatomical anomaly by transcatheter intervention or surgery.     

Fistule appendiculocutanée secondaire à une appendicite: à propos d’un cas

The appendico-cutaneous fistula in the wall, caused by appendicitis, is a very rare pathology. We report a case of appendicular perforing in a 65-year-old patient, appearing in the form of an appendiculo-cutaneous fistula.     

Un cas rare de thrombose artérielle secondaire à une endocardite aortique à Aerococcus viridans

Infective endocarditis is an uncommon, yet serious disease responsible for high morbidity and mortality, its incidence is estimated at 3–10 cases per 100,000 person-years. Most infective endocarditis cases emanate from streptococcus and staphylococcus. The incrimination of Aeroccocus viridans is rarely described in the literature and it has a high rate of embolic complication.We report the case of a 31-year-old male patient, with no prior medical history, who was admitted to the cardiology department of Ibn Rochd university center due to a prolonged fever for over 6 months. At admission, his general condition was preserved, he was febrile at 38.7 °C, claudication in the right lower limb with a decrease in the peroneal artery pulse, a graded 4/6 diastolic aortic murmur on auscultation, and no signs of heart failure. The transthoracic echocardiography revealed a type I bicuspid aortic valve disease, severe aortic regurgitation, moderate aortic stenosis, and vegetation implanted on the ventricular side of the right coronary cusp. CT angiography of the lower limbs revealed a bilateral total occlusion of the tibioperoneal trunks extended to the proximal portions of the posterior tibial arteries and peroneal arteries with collateral circulation, endovascular collection, and occlusive calcified plaque of the proximal part of the right anterior tibial artery and the collateral circle. Blood tests showed an inflammatory syndrome. Blood cultures detected Aerococcus viridans.The patient was first put on ceftriaxone, gentamycin, unfractionated heparin, and analgesic-antipyretic when necessary, he was then transferred to the cardiovascular surgery department for replacement of the aortic valve and permeabilization of the lower limbs by the FOGARTY technique. Post-surgical results were satisfying.In conclusion, infective endocarditis secondary to Aerococcus viridans is rare but appears to be virulent because most often discovered at the stage of complications. Therefore, good antibiotic therapy adapted to the antibiogram results in a good prognosis.     

Ostéomalacie secondaire à une tumeur mésenchymateuse phosphaturique de révélation tardive

Introduction

Osteomalacia is associated with diffuse pain and multiple fractures and therefore, diagnosis and treatment of this condition are necessary. Clinicians should be aware of an uncommon mechanism of osteomalacia where hypophosphataemia is secondary to renal phosphaturia because of the production by a mesenchymal phosphaturic tumor of FGF-23. This tumor should be localized and removed to cure this tumor-induced osteomalacia.

Neuropathie périphérique avec hypervitaminose B6 provoquée par l’automédication

IntroductionVitamin B6 is contained in a number of over-the-counter drugs and vitamin supplements. It may cause severe neurological troubles in case of overdosage.Case reportWe report the case of a 92-year-old women with gait disorders. A diagnosis of peripheral neuropathy with both motor and sensitive deficits was established and investigated. Blood level of vitamin B6 was measured to investigate a potential deficiency. Unexpectedly, the results showed hypervitaminosis B6, which appears to be due to self-administration of an over-the-counter drug containing vitamin B6. Discontinuation of this drug was associated with decrease in vitamin B6 level as well as gait improvement. We also discuss the toxicity of vitamin B6.ConclusionHypervitaminosis B6 remains a possible cause of peripheral neuropathy and it may be caused by self-administration of over-the-counter vitamin-containing drugs.     

Artériopathies périphériques juvéniles

Peripheral arterial disease (PAD) encompasses disease of all arteries of the body except the coronary arteries. The main etiology whatever the patient's age is atherosclerosis. Different etiologies can induce PAD especially when patients are younger than 50 years old and have no cardiovascular risk factors (smoking, hypertension, diabetes…). PAD that appears before 50 years old can be named juvenile PAD (JPAD) although there is no consensus about the definition. The aim of this work is to present the different etiologies of JPAD according to their hereditary, acquired or mixed origins. The following hereditary causes are addressed: Marfan syndrome, Ehlers-Danlos syndrome, homocystinuria, pseudoxanthoma elasticum, osteogenesis imperfecta “mid-aortic” syndrome. Among the acquired etiologies, inflammatory JPADs without extravascular signs such as atherosclerosis and Buerger's disease, inflammatory JPADs with extravascular signs as Takayasu's disease, Behçet's disease and Cogan's syndrome, JPADs like aortitis, embolic JPADs, iatrogenic JPADs, and mechanical or traumatic JPADs are described. Finally, mixed origins as thrombotic disease and fibromuscular dysplasia are presented. This work will assist clinicians in the diagnosis of JPAD.     

Développement d'un sarcome sur foyer ectopique hématopoïétique secondaire à une sphérocytose héréditaire : à propos d'un cas et revue de la littérature

IntroductionExtramedullary hematopoiesis is a complication of myeloproliferative neoplasms or of chronic hemolysis. The more frequent localizations are splenic, ganglionic or paraspinal. Rarely, extramedullary hematopoiesis is associated with solid cancer.Case reportWe report an original case of sarcoma located in an extramedullary hematopoiesis mass in a 72-year-old woman suffering from hereditary spherocytosis. An asymptomatic right paravertebral mass was found in 2004; the biopsy confirmed extramedullary hematopoiesis. In 2016, the patient was hospitalized due to paravertebral pain. Computed tomography showed the extension of the right paraspinal mass to pleura and mediastinum as well as vertebral bone lysis. Positron emission tomography showed an intense hypermetabolism. The biopsy showed undifferentiated sarcoma.ConclusionThis case report illustrates the risk of neoplastic transformation of extramedullary hematopoiesis, and the need for a biopsy when confronted to atypical aspect.     

Syndrome de Good et toxoplasmose congénitale secondaire à une réactivation maternelle pendant la grossesse

Introduction

Good syndrome is a rare condition in which thymoma is associated with hypogammaglobulinemia. It is characterized by an increased susceptibility to infections.

Rhabdomyolyse avec tétraparésie secondaire à une hépatite virale E chez un patient sous statines

IntroductionNeurologic and muscular damage associated with acute hepatitis due to hepatitis E virus (HEV) are rare and may be underdiagnosed.Case reportWe report the case of a 56-year-old man, presenting with flaccid tetraparesis secondary to an acute rhabdomyolysis induced by acute E virus hepatitis. He fully recovered after one month under supportive treatment.DiscussionRare cases of acute rhabdomyolysis induced by HEV infection have been reported in the literature. We discuss the potential adjuvant role of statin treatment in our patient. Unexplained acute neurological conditions should prompt the search for HEV infection.