Dépistage systématique d’une thrombose veineuse splénique ou portale après splénectomie

Background

Portal and/or splenic vein thrombosis (PSVT) is common after splenectomy. It can be a life-threatening complication, with a risk of bowel ischemia and portal hypertension. An early diagnosis allows an effective medical treatment and prevents life-threatening complications. There is no consensus regarding the benefit of systematic screening of patients after splenectomy for PSVT. We started in January 2012 a routine screening of PSVT after elective splenectomy. The aim of this study was to assess this policy.

Sarcoïdose splénique diagnostiquée par biopsie écho-guidée : à propos d’un cas

Introduction

Splenic localisation of sarcoidosis is common but rare as unique location. We report a case diagnosed by US-guided biopsy.

Parathyromatose : une cause rare d’hyperparathyroïdie récidivante

Introduction

Parathyromatosis is a rare cause of recurrent hyperparathyroidism. It results from hyperfunctioning parathyroid tissue scattered throughout the thyroid bed region.

Endocardite infectieuse aortopulmonaire d’évolution fatale : à propos d’un cas

We report the case of an aortic and pulmonary infective endocarditis in a 25-year-old patient originating from Guinea Conakry. The patient did not have any particular cardiovascular antecedent. He is allowed in a table of total heart failure and fever. The transthoracic echocardiography found vegetations on the level of sigmoid aortic and pulmonary ones. A probabilistic bi-antibiotherapy was instituted while waiting for the results of hemocultures. The patient was apyretic after one week, with regression of inflammatory biological syndrome. However, he was deceased after 20 days in a table of heart failure. The necropsy found vegetations on the level of sigmoid aortic and pulmonary ones, which were perforated, a right lung oedema and a cardiac liver.     

Acidose à la 5-oxoproline induite par le paracétamol : une cause rare d’acidose métabolique à trou anionique augmenté

The most common causes of high anion gap metabolic acidosis (HAGMA) are lactic acidosis, ketoacidosis, and intoxications. Nevertheless, clinicians can be faced with unexplained HAGMA, with a need to look for less common etiologies. We describe a case of 5-oxoproline (pyroglutamate) acidosis due to chronic acetaminophen ingestion at therapeutic dose in a 79-year-old inpatient. The pathophysiology of this condition is detailed, with abnormalities in the gamma-glutamyl cycle due to acetaminophen ingestion and severe chronic morbidities, resulting in glutathione and cysteine deficiency and then accumulation of 5-oxoproline. In HAGMA, when usual causes have been excluded, 5-oxoproline acidosis should be suspected in patients with chronic morbidities and acetaminophen ingestion. This diagnosis should be kept in mind because it generally resolves quickly with cessation of acetaminophen and administration of intravenous fluids.     

Entéropathie exsudative sévère compliquant une primo-infection à cytomégalovirus chez un adulte immunocompétent

IntroductionClinical expression of cytomegalovirus (CMV) infection is numerous and depends on the immune status of the host. In immunocompromised patients, CMV disease corresponds to reactivation of the virus with tissue damage responsible for significant morbidity and mortality. In immunocompetent adults, primary CMV infection is usually asymptomatic but may rarely result in severe organ damage.ObservationWe report the case of a 28-year-old man, considered immunocompetent and without medical history, presenting with a primary CMV infection revealed by a severe protein-losing gastroenteropathy (serum albumin level: 18.9 g/L). The CT scan showed a gastro-duodeno-jejuno-ileitis pattern. Upper intestinal endoscopy revealed diffuse ulcerated and congestive gastritis predominantly in the fundus. Histological analysis of the biopsies showed no viral inclusion and no immunohistochemical staining reaction, but a high viral load (5.61 log). Treatment was symptomatic associated with anticoagulation due to the major hypoalbuminemia. The patient slowly recovered, and normal clinical examination and blood tests were observed two months after the onset of symptoms.ConclusionSevere CMV organ involvement in the immunocompetent patient is very rare but potentially serious. Digestive involvement complicated by exudative enteropathy is possible. Evolution is usually favorable without the need for antiviral treatment.     

La cellulite de Wells : à propos d’une observation

Introduction

Wells's cellulitis is a rare eosinophilic dermatose characterized by an inflammatory erythematous eruption, often associated with eosinophilia, and suggestive histologic features. The differential diagnosis with other eosinophilic dermatitis is problematic. The treatment is typically based on systemic steroids.

Pancréatite aiguë inaugurale d’une vascularite à IgA de l’adulte : une manifestation inhabituelle

Introduction

IgA vasculitis is a systemic small vessel leukocytoclastic vasculitis characterized by skin purpura, arthritis, abdominal pain and nephritis. Most of the abdominal complications are due to edema and hemorrhage in the small bowel wall, but rarely to acute secondary pancreatitis.

Coma au décours d’une chimiothérapie. Et si le 5 FU était en cause ?: Discussion à propos d’une observation

5FU is one of the most frequently used antioncogenic and cytostatic drug in digestive oncology. It may cause severe adverse events, such as encephalopathy, possibly based on hyperammoniemia, and may lead to coma. We report here the case of a coma with a favorable outcome following 5FU chemotherapy. As any other etiologic findings came to light, hyperammoniemia was discussed as a credible cause.     

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.