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.     

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.     

La prise en charge des lésions anopérinéales de la maladie de Crohn: revue de la littérature

The anoperineal Crohn??s disease lesions pose a several problems in diagnostic and therapeutic steps. The frequency of these lesions was around 21 to 23% in the literature [1]. The data in the literature are still insufficient in the absence of studies devoted to this location particularly debilitating. The purpose of this literature review is to highlight the current diagnostic and therapeutic modalities and new recommendations.     

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.     

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.     

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.     

Syndrome de larva migrans viscéral avec atteinte cardiaque : une observation et revue de la littérature

IntroductionToxocariasis is a roundworm infection that may be associated with serious cardiac manifestations. We report one case and review another 12 cases in the literature.Case reportA 74-year-old man, presented with clinical features of myopericarditis. Eosinophil count was 20,000/mm³. The ELISA and Western Blot were positive for Toxocara canis. The patient was treated with corticosteroids and antiparasite treatment. The outcome was rapidly favorable.DiscussionIn the other 12 cases, the cardiac manifestations were often severe: six myocarditis, three tamponades and three Loeffler's endocarditis have been published. Four therapeutic strategies have been reported: symptomatic treatment alone was associated with worse progressive; antiparasite treatment alone or companied with corticosteroids and corticosteroids alone had good results.ConclusionThe toxocariasis should be investigated systematically in case of eosinophilic cardiomyopathy. The treatment strategy is still controversial.     

La pancréatite chronique tropicale: une entité rare, à propos d’un cas et revue de la littérature

Tropical chronic pancreatitis (TCP) is a juvenile type of non alcoholic chronic pancreatitis. It is found mostly in developing countries, predominantly in India with a prevalence estimated at 0.02% of the general population but rarely in Africa. We are hereby reporting a case of tropical chronic pancreatitis in an 11 year old girl. The etiopathogenic factors are essentially malnutrition and genetic predispositions with the mutation of the N34S gene encoding for serine protease (SPINK1) in the homozygote or heterozygote state. Abdominal pain is the main symptom. Pancreatic calcifications are the constant morphological findings. The most feared complication is the occurrence of pancreatic cancer. Treatment consists of management of pain and eventual complications.     

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.     

Maladie de Von Hippel-Lindeau avec mutation de novo et multiples lésions pancréatiques symptomatiques. À propos d’une observation et revue de la littérature

The Von Hippel-Lindau (VHL) is a rare, autosomal dominant multisystemic disease predisposing to the development of benign and malignant tumors richly vascularized. It is caused by germline mutations of the VHL tumor suppressor gene. During this disease, pancreatic disease is common but clinical manifestations are rare. Pancreatic damage usually consists of multiple cysts, more rarely serous cystadenomas or isolated cysts. We report the case of a patient who presented with acute pancreatitis during a Von Hippel-Lindeau de novo with pancreatic achieved by several types of lesions. The interest of our case lies in the achievement of pancreatic fashion and clinical expression, rarely described and the need to remember that this condition also exists in sub- Saharan Africa should be sought even in the absence of family history VHL.     

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.