Frequency of auto‐antibodies of type 1 diabetes in adult patients with celiac disease

Both celiac disease (CD) and type 1 diabetes (T1D) are autoimmune diseases resulting from a complex interplay between genetic susceptibility and environmental factors.AimIn this retrospective study, we determined the frequency of auto‐antibodies of T1D in adult patients with active CD.Materials and methodsEighty adult patients with active CD were included in our study. Ninety healthy blood donors (HBD) served as control group. Anti‐glutamic acid decarboxylase IgG antibodies (GAD‐Ab), anti‐tyrosine phosphatase IgG antibodies (IA2‐Ab), and anti‐zinc transporter IgG antibodies (Zn‐T8‐Ab) were determined by enzyme‐linked immunosorbent assay (ELISA) for patients and control group. For statistical analysis, we used Chi‐square or Fisher''s exact test.ResultsOut of 80 patients, 10 (12.50%) had auto‐antibodies of T1D vs. only one in control group (1.11%) (p = 0.003). Simultaneous presence of GAD‐Ab, IA2‐Ab, and Zn‐T8‐Ab was found in one patient (1.25%). Nine patients had only GAD‐Ab. IA2‐Ab and Zn‐T8‐Ab were absent in all HBD. The frequency of GAD‐Ab was significantly higher in CD patients than in HBD (12.5% vs 1.11%, p = 0.003).ConclusionThe present study has shown that CD is associated with a high frequency of auto‐antibodies of T1D. Screening for T1D in this population, at risk for other autoimmune diseases, may be useful.     

Molecular Epidemiology of Rabies in Wild Canidae in Tunisia

Rabies is a viral zoonosis that is transmissible to humans via domestic and wild animals. There are two epidemiological cycles for rabies, the urban and the sylvatic cycles. In an attempt to study the epidemiological role of wild canidae in rabies transmission, the present study aimed to analyze the genetic characteristics of virus isolates and confirm prior suggestions that rabies is maintained through a dog reservoir in Tunisia. Virus strains isolated from wild canidae were subject to viral sequencing, and Bayesian phylogenetic analysis was performed using Beast2 software. Essentially, the virus strains isolated from wild canidae belonged to the Africa-1 clade, which clearly diverges from fox-related strains. Our study also demonstrated that genetic characteristics of the virus isolates were not as distinct as could be expected if a wild reservoir had already existed. On the contrary, the geographic landscape is responsible for the genetic diversity of the virus. The landscape itself could have also acted as a natural barrier to the spread of the virus.     

Multifocal tuberculosis revealed by multiple cutaneous gummas in the immunocompetent

Cutaneous tuberculosis is rare. Its occurrence in multifocal tuberculosis (MT) is uncommon and happens frequently in the context of immunosuppression. We report the case of MT with multiple cutaneous gummas and bone and lung involvement that occurred in an apparently immunocompetent patient.     

Kaposiform hemangioendothelioma with fatal income: Kasabach–Merritt phenomenon and hypercalcemia

Kaposiform hemangioendothelioma is a rare, borderline tumor that typically occurs during early childhood. Kasabach–Merritt phenomenon is a complication characterized by a consumptive coagulopathy resulting from the localized intravascular coagulation. Hypercalcemia generation is a rare association that was related in our case to parathyroid hormone‐related protein produced by this angioma.     

Myelopathy after zoster virus infection in immunocompetent patients: A case series

ContextAfter primary infection, varicella zoster virus (VZV) becomes latent in ganglionic neurons. If immunity declines, VZV is reactivated and can spread to the dermatome depending from this ganglion and in some cases to the spinal cord. Myelopathy is rare and may develop in the absence of skin rash making the diagnosis very difficult.FindingsFrom 1994 to 2014, we collected five observations of clinically and laboratory confirmed zoster myelopathy. The age of our patients ranged from 14 to 78. They did not have any significant past medical history. Four patients had a history of radicular rash. After 3 weeks (4–45 days), patients presented paraparesis, sensory loss, and sphincter dysfunction. Cerebrospinal fluid (CSF) analysis revealed an elevated protein level (5/5cases) and pleocytosis (2/5 cases). Spinal cord magnetic resonance imaging (MRI) demonstrated T2 hyper intense lesions with swelling and contrast enhancement. The diagnosis was supported by laboratory evidence, including the detection of VZV antibodies in the CSF. All patients received intravenous acyclovir and two patients received IV methylprednisolone. A marked improvement was observed in most of the patients within 2 months.Conclusion /Clinical RelevanceBased on our patients and on previous reports, we highlight the possibility of the occurrence of VZV myelopathy in immunocompetent subjects. The diagnosis must be evoked even in the absence of typical skin lesions. In this case, spinal cord MRI and virological tests are useful tools for the diagnosis. We also emphasize on the importance of accurate diagnosis to enable the specific treatment and ameliorate the outcome.