Arthrite réactionnelle à Clostridium difficile : à propos de deux observations et revue de la littérature

Introduction

Reactive arthritis due to Clostridium difficile infection is uncommon.

Les œsophagites disséquantes: à propos de trois observations

Introduction

Oesophagitis dissecans is a rare disease. It has an unknown etiopathogeny. Diagnosis is reliably obtained by endoscopy, however, its treatment is not codified.

Patients and methods

Retrospective study (2001–2008) registered three cases of oesophagitis dissecans in the hepatogastroenterology department, Hassan-II University Hospital in Fez.

Results

The patients are 31, 20 and 37 years old, respectively. Two of them are male. The endoscopy exam was preceded by a history of dysphagia in two, and a history of anaemia in the other. In the three patients, endoscopy feature was characterized by the presence of areas mucosa forming a transverse streaks. The mucosal detachment was induced by the contact with biopsy pince witch allows to diagnosis.

Conclusion

It is a benign affection, therefore it is rare and considered as an exceptional aetiology of chronic dysphagia. Diagnosis is easy but its treatment remains to be codified.     

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.

La tuberculose intestinale : à propos de 11 observations

Introduction

In recent years, the incidence of intestinal tuberculosis has been increasing. This is, in part, due to the pandemic of HIV. Intestinal tuberculosis can be difficult to diagnose and needs a high index of suspicion. The aim of our study is to describe epidemiological, clinical and therapeutic aspects of intestinal tuberculosis in Tunisian adults.

Material and methods

Retrospective study of all intestinal tuberculosis recorded from January 1996 to December 2007 in gastroenterology B department of Rabta Hospital in Tunis.

Results

Eleven patients were included: five males and six females. Mean age was 35. Clinical manifestations were dominated by abdominal pain. Biologic signs of inflammation were constant. The intradermal tuberculin reaction was positive in 27% of the cases. Mycobacterium tuberculosiswas identified in sputum or urine in two patients. HIV serology was negative in all cases. Lesions were more frequently localized in the ileo-caecal area (36%). Ulcerations were present in 72% of the cases. In histology reports, a granuloma with caseating necrosis was present in three cases (27%). M. tuberculosis was isolated on ileo-colonic biopsies in three patients (27%). Morphologic studies showed ileo-caecal valve or ileal stenosis in six patients (54.5%). Extraintestinal tuberculosis was associated in 45% of the cases. Antituberculous therapy was given in seven patients for a mean duration of nine months (four patients were lost). Clinical and endoscopic outcome was favourable in 86% of the cases.

Conclusion

Although Tunisia is a high endemic country for tuberculosis, intestinal tuberculosis is rare. However, it should be suspected mainly in patient having history of tuberculosis or in case of characteristic clinical or radiological signs.     

Entéropathies exsudatives : à propos de cinq observations et revue de la littérature

Objective

Protein-losing enteropathy (PLE) is a rare entity with multiple etiologies. The diagnosis is confirmed by the elevation of faecal alpha-1-antitrypsin clearance. We report five cases of PLE and review the clinical characteristics and prognosis factors.

Methods

We retrospectively reviewed the medical report of 5 patients with PLE seen at the Department of internal Medicine between Hedi Cheker Hospital between 1996 and 2012.

Results

Five women with a mean age of 44.8 years (25–70 years) were studied. The initially suggestive clinical symtomatology was lower edema was in 3 cases, ascites in a patient while EE was discovered incidentally in another case. There were no gastrointestinal symptoms in all cases. Biologically, hypoproteinemia with hypoalbuminemia was found in all patients, hypogammaglobulinemia in 3 patients and lymphopenia in 3 cases. Hypocalcemia was present in one case, moreover, there was no digestive malabsorption in others cases. Renal function was normal without proteinuria in all cases. PLE was confirmed by the elevation of the clearance of alpha -1-antitrypsin in all patients. The investigations revealed systemic lupus erythematosus (SLE) in one case, a duodenal lymphangiectasia associated with non specific ulcerative ileitis in another. Celiac disease was highly likely in a patient, an iatrogenic origin was implicated in another (magnesium hydroxide). However, no cause was found in the fifth patient. All patients received a high-protein diet with specific treatment in three cases. The outcome was good in four patients with resolution of edema and correction of laboratory abnormalities.

Conclusion

PLE is a rare entity with digestive or nondigestive causes. Dietary measurement is generally indicated associated with the treatments of the more common causes.     

Ulcères nécrotiques et purpuriques des membres inférieurs révélant un scorbut : à propos de deux observations

BackgroundScurvy is a clinical syndrome resulting from ascorbic acid deficiency. Although presently rare in the developed world, it continues to occur within certain susceptible populations, particularly the elderly and those with dietary habits with low vitamin C intake.CasesTwo men aged 87 and 69 were referred with multifactorial, progressive ulceration of the lower limbs, without scarring, in a context of arterial disease and other associated comorbidities. In both cases, the level of vitamin C was undetectable. An improvement in the necrotic component and in the purpura was promptly observed after vitamin C supplementation.ConclusionsDiagnosis of scurvy can be challenging. This report highlights the importance of maintaining a high index of suspicion for scurvy in atypical necrotic ulcerations of lower extremities with poor response to standard therapy especially in populations at high risk of vitamin C deficiency. Early diagnosis can improve patient prognosis.     

Syndrome de Budd-Chiari primaire: à propos de quatre observations et revue de la littérature

Introduction

Budd-Chiari syndrome results from obstruction of hepatic venous drainage from the hepatic venules to the distal inferior vena cava. It is a rare condition whose causes are multiple.

Materials and methods

We report four clinical observations collected at the Service of Internal Medicine, Hospital University Center Hassan II, Fez, between December 2004 and February 2007.

Results

These two cases of Budd-Chiari syndrome secondary to Behcet’s disease, occurred in the first observation after ten years of disease progression. In addition, thrombosis of hepatic veins was discovered fortuitously in Observation number 4 during an abdominal scan, performed before the presence of an inflammatory syndrome. The Budd-Chiari syndrome was secondary to a primary antiphospholipid syndrome in the second observation and a paroxysmal nocturnal hemoglobinuria in the third case.

Conclusion

The Budd-Chiari syndrome is associated in two thirds of cases with one or more underlying prothrombotic disorders, including myeloproliferative disorders, which are the main primitive in about 50% of the cases, mutation of factor V Leiden or a deficiency of protein C in about 25% of the cases, antiphospholipid syndrome in about 20% and paroxysmal nocturnal hemoglobinuria or Behçet’s disease in about 5% of the cases. The Budd-Chiari syndrome may be asymptomatic, discovered incidentally by an abdominal doppler ultrasound or an abdominal scan, found in 20% of cases. The chronic form of Budd-Chiari syndrome is reported in 60% of the cases.     

Ecchymoses diffuses révélant une maladie de Wilson : à propos d’un cas

Introduction

The presence of a psychiatric disorder during the course of an organic disease is a common cause of delayed diagnosis.

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.

Le GIST rectal: à propos de deux observations et une revue de la littérature

Gastrointestinal stromal tumors (GISTs) are uncommon mesenchymal tumor of the gastrointestinal tract, and are defined with histological and immunohistological features. They develop more often in the stomach and in the small intestine, but are rarely seen in the rectum. We present two cases of histologically and immunohistochemically confirmed rectal GISTs. Their clinical and imaging and treatment features are illustrated, and the relevant literature is reviewed.     

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.     

Prévalence de l’atteinte artérielle macrovasculaire des 4 membres dans la sclérodermie systémique : à propos de 14 patients

Introduction

Trophic disorders of the extremities are a common complication of systemic sclerosis (SSc), mainly related to microvascular damage. However, SSc seems to be a risk factor for premature athero-thrombotic disease that can affect the peripheral arteries, participate in the occurrence of trophic disorders and promote the occurrence of infectious complications. The objective of this study was to assess the prevalence of arterial disease of the limbs in SSc patients.