Sensibilisation parentérale du lapin aux protéines du lait de vache : effets sur les paramètres électrophysiologiques de l’intestin

Objectives

Study of the effect of cow's milk protein (β-lactoglobulin [β-LG] and α-lactalbumin [α-LA]) on the electrophysiological parameters of the intestine rabbits sensitized to these allergens, directly incriminated in the non immunologic allergy to cow's milk proteins and their systemic effects.

Methods

The interaction of the proteins (marked to the ¹⁴C-formol), with the mucous intestinal of parenteraly sensitized and some control rabbits, was followed-up in vitro on fragments of ileums mounted in Ussing chamber. The electrophysiological parameters which characterize the tissue to the basal state then in the time, in regular intervals, were measured after stimulation by the proteins deposed in the mucous compartment.

Results

The interaction of β-LG and α-LA with the intestinal mucous, significantly more increased among the sensitized than some control rabbits, is associated to a significant increase of the short circuit current and the difference of potential while the conductivity remain unchanged.

Conclusion

These results suggest that the interaction of the sensitizing protein with intestinal mucous caused anomalies of hydroelectrolytic transport at the immunized animals and establishes an interesting approach for the understanding of physiopathological mechanisms of the increased permeability at these proteins.     

Polyradiculonévrite aiguë révélant un lupus érythémateux systémique : une présentation inhabituelle d’évolution fatale

Introduction

Neurological manifestations of systemic lupus erythematosus are common and numerous. They mainly involve the central nervous system, peripheral involvement being rare. Acute polyradiculoneuropathy is very uncommon.

Case report

We report a 44-year-old man, who presented with acute polyradiculoneuropathy revealing systemic lupus erythematosus. Outcome was fatal despite treatment with corticosteroids and immunoglobulin.

Conclusion

Acute polyradiculoneuropathy is a very rare manifestation of systemic lupus erythematosus and can compromise functional and life prognosis. Early diagnosis and management are crucial.     

Déficit en cuivre et neuropathie périphérique compliquant une gastrectomie

Introduction

Bariatric surgery may be indicated in patients with morbid obesity. Peripheral and central neurological complications can occur after bariatric surgery.

Observation

We report a 47-year-old woman who presented with a tetraparesis related to copper deficiency after sleeve gastrectomy for morbid obesity.

Conclusion

Neurological complications related to copper deficiency can occur after bariatric surgery.     

Dégénérescence cérébelleuse paranéoplasique révélant un cancer du sein : à propos d’un cas

Introduction

Paraneoplastic cerebellar degeneration may be a manifestation indicative of lung, gynecological or breast cancer. Nevertheless, breast cancer is rarely revealed by the occurrence of a paraneoplastic syndrome.

Case report

We report a 38-year-old patient who presented a paraneoplastic cerebellar degeneration with anti-Yo antibodies as the presenting manifestation of a breast cancer.

Conclusion

The diagnosis of a paraneoplastic neurological syndrome (PNS) should lead to urgent and comprehensive screening for cancer oriented by the type of PNS and the nature of the anti-neuronal antibody.     

Thrombophlébite cérébrale : une complication rare de l’infection aiguë à cytomégalovirus

Introduction

Acute cytomegalovirus (CMV) infection increases the risk of vascular thrombosis but reports of cerebral venous thrombosis are rare.

Case report

We report a 36-year-old woman who presented with a cerebral venous thrombosis and acute CMV infection heralded by a cytolytic hepatitis. Heterozygous factor V Leiden mutation was also identified. The patient was treated with anticoagulation for 1 year with favourable outcome.

Conclusion

Serologic tests for CMV infection should be performed in case of cerebral venous thrombosis with liver cytolysis or flu-like symptoms. CMV infection often triggers thrombosis in combination with other inherited or genetic predisposing risk factors that should always be searched.     

Mort subite au cours d’une dégénérescence cérébelleuse subaiguë paranéoplasique avec dysautonomie associée aux anticorps anti-Hu révélant un cancer bronchique à petites cellules

Introduction

Paraneoplastic syndromes are a rare cancer complication with a frequent subacute evolution.

Observation

A 62-year-old man was admitted presenting with a cerebellar syndrome and orthostatic hypotension with dysautonomia. Anti-Hu antibody research was positive. A subcarinal adenopathy biopsy found out a small cell lung carcinoma. Despite a treatment with immunoglobulin and chemotherapy, the patient died suddenly, after a raise of dysautonomia symptoms.

Conclusion

Sudden death observations represent exceptional complications of paraneoplastic syndrome. They might be secondary to arrhythmias, ictal asystol or laryngospasm. Systematic research of paroxystic heart arrhythmias with holter-ECG in paraneoplastic syndrome may prevent sudden deaths.     

Péricardite récidivante : traquer le mésotheliome péricardique primitif

Introduction

Most of recurrent pericarditis are idiopathic and only 15 to 20% have a specific diagnosis. Primary pericardial mesothelioma is a rare cause of recurrent pericarditis. Diagnosis can be challenging and antedates patient's death in only 10 to 20% of cases. Histology of mesothelioma and immunohistochemistry are mandatory for the diagnosis. Median of survival before using pemetrexed was about 6 months after diagnosis.

Case report

We report the history of a 64-year-old woman for which repeated biopsy for recurrent pericarditis was necessary to diagnose a primary pericardial mesothelioma. The first biopsy had only found mesothelial hyperplasia.

Conclusion

This case report highlights the necessity of repeat pericardial biopsy in the case of adverse outcome.     

Iléite à cytomégalovirus chez une personne âgée non immunodéprimée : à propos d’une observation

Introduction

Cytomegalovirus ileitis occurs rarely in immunocompetent subjects.

Case report

An 88-year-old woman presented with severe pain located in right iliac fossa. Biological tests showed an increase in C-reactive protein and neutrophils. Colonoscopy revealed a severely ulcerated and inflamed terminal ileal mucosa. Histopathological analysis of biopsies showed a typical cytopathic effect with ballooned cells and intranuclear inclusions, confirmed by positive immunological marking with anti-cytomegalovirus antibodies. Cytomegalovirus polymerase chain reaction in the plasma showed positive activity. The patient was successfully treated with valganciclovir.

Conclusion

The predominant or isolated ileal location of cytomegalovirus infection should be known, especially in the elderly because aging could be a risk factor.     

Paralysie du nerf récurrent au cours d’une maladie de Lyme : à propos de deux observations

Introduction

Neuroborreliosis can be a difficult diagnosis which requires epidemiologic, clinical and biologic arguments.

Case reports

We report two patients who presented with a recurrent laryngeal nerve palsy with positive Lyme serology and favorable outcome after antibiotic therapy. In one case, a lymphocytic meningitis with intrathecal production of specific antibodies was evidenced.

Conclusion

Recurrent laryngeal nerve palsy is an uncommon manifestation of neuroborreliosis. Lyme serology is an important tool when neurologic disorder occurs because of an atypical course of Lyme disease.     

Les glomérulopathies associées aux néoplasies myéloprolifératives

Purpose

Myeloproliferative neoplasms (MPN) are hematological disorders characterized by clonal expansion of one or more medullary lines. Renal complications are rare, chiefly as acute renal failure. Glomerular involvement is exceptional

Methods

We report on a retrospective multicenter case series of eight patients who presented with a glomerulopathy (GP) associated with MPN

Results

All GP were revealed by a major proteinuria frequently associated with nephrotic syndrome and oedema. Histology was mainly characterized by lesions of focal segmental glomerulosclerosis associated with increased mesangial cellularity. The pathophysiology is still unclear but platelet-derived growth factor (PDGF) and transforming growth factor-β (TGF-β), which play a central role in the MPN may be involved. A majority of patients developed chronic renal failure despite of a therapy intended to block the renin-angiotensin system

Conclusion

Monitoring of proteinuria during the follow-up of MPN would allow earlier diagnosis of renal involvement. Further studies on a larger scale are needed to specify the pathophysiological mechanisms involved and the management of these complications     

Syndrome d’encéphalopathie postérieure réversible induit par un décongestionnant nasal contenant de la pseudo-éphédrine

Introduction

Posterior reversible encephalopathy syndrome is a clinico-radiological entity characterized by neurologic symptoms in association with usually reversible bilateral posterior hemispheric oedema on neuroimaging. Many pathological conditions and treatments have been associated with this syndrome.

Case report

We report a 19-year-old woman, followed-up for hypocomplementemic urticarial vasculitis, who presented with a posterior reversible encephalopathy syndrome induced by the intake of an over-the-counter cold remedy containing pseudoephedrine. Clinical manifestations and radiological abnormalities resolved after anti-hypertensive therapy and withdrawal of sympathomimetic drug.

Conclusion

The diagnosis of posterior reversible encephalopathy syndrome should be considered in patients with compatible clinical and radiological presentation because of its potential reversibility with an appropriate management. Intake of drugs, including over-the-counter cough and cold drugs, should be looked for in the history as well as autoimmune disorders.     

Anorexie psychogène et carences vitaminiques sévères dans les suites d’une gastrectomie longitudinale

Introduction

Morbid obesity is an emerging condition in the general population. Bariatric surgery, which has demonstrated its effectiveness for weight loss, mortality and morbidity related to obesity, is required in some patients. However, it may be associated with various adverse effects, including vitamin deficiencies.

Case report

We report a 33-year old man who presented central and peripheral neurological deficits and cardiac manifestations related to multiple vitamin deficiencies, following “sleeve” gastrectomy. The vitamin deficiencies were related to insufficient ingesta secondary to psychogenic anorexia. The patient improved with vitamins, antidepressant drugs and atypical neuroleptics.

Conclusion

Post-operative complications of “sleeve” gastrectomy include vitamin deficiencies that can develop in the context of psychogenic anorexia and ingesta reduction, in the absence of any digestive malabsorption.     

Complications de la gastroentérite à éosinophiles : une observation et revue de la littérature

Introduction

Eosinophilic gastroenteritis is an unusual disease characterized by an eosinophilic infiltration of the gastrointestinal tract. The esophageal location of this disorder is uncommon and is usually revealed by dysphagia. Diagnosis is obtained by histology during endoscopy after exclusion of differential diagnosis. Treatment is based on systemic corticosteroids, which improve dramatically symptoms and endoscopic lesions.

Case report

We report an 88-year-old man who presented eosinophilic gastroenteritis with esophageal injury complicated by gastrointestinal haemorrhage and fistule.

Conclusion

Eosinophilic gastroenteritis may have a potentially unfavourable outcome. The treatment of complicated forms is not codified and often empirical.     

Encéphalopathie de Gayet-Wernicke après sleeve gastrectomie pour obésité morbide

Introduction

Bariatric restrictive interventions, as sleeve gastrectomy or gastric banding can cause metabolic complications, especially when vomiting is present, such as thiamine deficiency that can lead to Wernicke's encephalopathy.

Case report

A 31-year-old man with a 47 kg/m² body mass index presented with Wernicke's encephalopathy, with ophtalmoplegia, nystagmus, ataxia and confusion, followed by a Korsakoff syndrome, occurring two months after a sleeve gastrectomy. MRI showed hyperintense signals on T2 and FLAIR image in both thalamus, periaqueducal area and mamillary bodies.

Conclusion

A close clinical and biological monitoring is required in the first year after surgery, especially if vomiting occurs. Early diagnostic and treatment are needed to avoid severe sequelae.     

Infection disséminée au virus varicelle-zona avec gastrite hémorragique compliquant une leucémie lymphoïde chronique : une observation et revue de la littérature

Introduction

The reactivation of varicella-zoster virus occurs in immunocompromised patients, especially in cases of hematological malignancy. Disseminated reactivation could involve digestive tract with life-threatening condition.

Case report

A 76-year-old woman, with a history of chronic lymphocytic leukemia, presented with left hypochondrium pain, and a vesicular rash with hemorrhagic shock that revealed an hemorrhagic gastritis due to varicella-zoster virus. The literature review identified 28 additional cases of gastrointestinal mucosal damage during reactivation of varicella-zoster virus. Mortality is 40%. We report here the first case in the course of low-grade lymphoid malignancy.

Conclusion

Acute gastrointestinal symptoms in immunocompromised patients should evoke a varicella-zoster virus reactivation with gastrointestinal involvement. This clinical manifestation, although rare, should not be ignored because of its severity.     

Cholangite sclérosante de réanimation : évolution favorable sous acide ursodésoxycholique et fénofibrate

Introduction

Ischemic cholangitis in intensive care unit is a recently reported liver disease in patients who have had a prolonged mechanical ventilation and vasopressive drug support for multiple organ deficiency. Prognosis is usually poor and the only life-saving therapy is liver transplantation despite ursodesoxycholic acid treatment.

Case report

We report a 63-year-old man who presented with a sclerosis cholangitis after a month in intensive care unit, effectively treated with fenofibrate and ursodesoxycholic acid. Recent reports underline fenofibrate efficacy in the treatment of primary biliary cirrhosis, especially in association with ursodesoxycholic acid. This treatment has prevented liver transplantation for our patient with a correct quality of life.

Conclusion

The addition of fibrate to ursodesoxycholic acid improves persistent cholestasis in sclerosing cholangitis.     

L’entérite : une manifestation peu fréquente et corticosensible du lupus érythémateux systémique

Introduction

. Lupus enteritis is a rare manifestation of systemic lupus erythematosus. The clinical manifestations are variable including abdominal pain, diarrhea, nausea and vomiting. Lupus enteritis is thought to be related to vasculitis.

Case reports

. We report here three new cases. All three patients aged of 45, 24 and 43 years (two females and one male) were admitted for abdominal pain, vomiting and diarrhea, and fulfilled the ACR criteria of systemic lupus erythematosus. The diagnosis of lupus enteritis was retained on the CT scan findings and the favorable outcome on corticosteroids after infectious etiologies were excluded.

Conclusion

. Lupus enteritis is thought to be one of the most common causes of acute abdominal pain in systemic lupus erythematosus. The diagnosis is based on clinical, radiological and biological findings. A good response to corticosteroids is usually reported.     

Maladie de Niemann-Pick de type B : description clinique de trois cas familiaux

Introduction

The Niemann Pick disease type B is a rare deficiency in sphingomyelinase activity, autosomal recessively inherited.

Case reports

We report three patients (two men, one woman) of the same family, who showed pulmonary and hepatosplenic lesions, usually present in the disease but also adrenal gland lesions confirmed by tomodensitometry.

Conclusion

The current treatment of Niemann Pick disease is purely symptomatic awaiting the use of enzymatic replacement therapy which has been successfully experimented in animal model.     

Complications infectieuses induites par le mésusage de la buprénorphine haut dosage (Subutex) : analyse rétrospective de 42 observations

Purpose

Misuse of high-dose buprenorphine (HDB), mainly by injection, is responsible of frequent infectious adverse events.

Methods

This is a retrospective study of infectious complications occurring in patients using HDB by injection. Forty-two cases were identified (29 men and ten women) and the data were collected between March 1999 and December 2008.

Results

The infectious complications included cutaneous infections (27 cases), endocarditis (nine cases), osteoarticular infections (four spondylodiscitis and one sacroiliitis), and a vascular embolism with decrease in visual acuity.

Conclusion

The results of HDB maintenance treatment must be improved, both from the point of view of substitution and to limit its misuse by intravenous route injection. Health professionals have to play an important role in drug addict patients’ education and supervision, to prevent buprenorphine injection and related infectious complications.