Malaria after chemotherapy for hematological malignancies.

The treatment of cancer, whether a solid tumor or a malignant hemopathy, is accompanied by bouts of infection, the severity and prognosis of which are often correlated to the patient's immune status. In Gabon, where the transmission of Plasmodium falciparum malaria is perennial, the prevalence - around 36% in Libreville - increases in older children and adults. Few authors have described the involvement of this parasite during fever after chemotherapy for hematological malignancies. This work reports three cases of malaria including two severe and one with neutropenia occurring in patients treated for hematological neoplasms.

Anticoagulant-induced pseudothrombocytopenia after a plasmodium falciparum infection in a five-year-old child.

Pseudothrombocytopenia or artefactual thrombocytopenia is an abnormally low number of platelets due to their agglutination in a sample tube, with no ex vivo clinical translation. It occurs in ethylene diamine tetraacetic (EDTA) test tubes. Non-EDTA anticoagulants, such as citrate, fluoride oxalate, and heparin lithium, may be responsible for it, alone or in combination. It can occur in patients with autoimmune diseases, neoplasia, atherosclerosis, liver disease, or infections. We report the case of a 5-year-old child, who after falciparum malaria showed persistent thrombocytopenia. Further exploration has led to the conclusion of pseudothrombocytopenia due to three anticoagulants: EDTA, citrate, and fluoride oxalate.

Pregnancy in autoimmune diseases in the sub-Saharan zone: the experience of the University Hospital of Libreville Department of Internal Medicine.

Autoimmune diseases are a group of heterogeneous conditions responsible for polymorphic clinical and biological manifestations. Because pregnancy activates them and promotes gestational complications, it is difficult for women with these diseases. Pregnancy and autoimmune diseases have rarely been studied in sub-Saharan Africa. We report the experience of the Internal Medicine Department of the University Hospital of Libreville. Conducted retrospectively for 2008 through 2011, and prospectively from 2012 through August 31, 2018, this descriptive and analytical study examined the records at the Department of Internal Medicine of the University Hospital Center of Libreville of women with a known autoimmune disease, receiving regular care there, and who became pregnant after the diagnosis. During pregnancy, women were monitored and manÂged simultaneously in the departments of obstetrics and internal medicine. Data considered for this study were demographic data (Âge, sex, social status), type of autoimmune disease, including the diagnosis, the therapies used, extent of disease control, and time from diagnosis to each pregnancy. Obstetric data include the number of fetuses, obstetric complications, gestational Âge at and route of delivery, fetal sex, and Apgar score to 5 minutes (normal ≥ 7). Women had the following autoimmune diseases : systemic lupus erythematosus (SLE) (n = 16), Sjögren's disease (n = 3), inflammatory myopathy (n = 2), rheumatoid arthritis (n = 1), primary antiphospholipid syndrome (APS) (n = 1), and Still disease (n = 1).The overall averÂge Âge at diagnosis was 26.6 years (range : 13-40). The 24 women had 32 pregnancies. The mean interval from diagnosis to first pregnancy was 3.3 years, to the second pregnancy also 3.3 years (n = 6), and to the third (n = 2), 5 years. Disease was controlled for at least 2 years (n = 23) except for one woman with primary APS. Therapeutically, corticosteroids were used alone (n = 2) or combined with other immunomodulatory therapies (n = 32). Gestational complications included spontaneous abortions in the first trimester (n =2), in utero deaths (n = 2), perinatal death on day 12 (n = 1), and eclampsia (n = 2), one of which was complicated by a pulmonary embolism in the first pregnancy. The mean gestational Âge at delivery was 37 weeks. Intrauterine growth restriction affected 11 fetuses, and preterm delivery 18. There were 11 cesarean deliveries and 16 vaginal. Mean birth weight was 2353.3 grams, Apgar was ≥ 7 for all neonates except in one case of dermatomyositis complicating a neonatal death. The sex ratio was 13 male infants per 17 females. Women with optimal disease control can become pregnant and have positive pregnancy outcomes. This possibility has been little explored in sub-Saharan Africa; mystical-religious notions of conceptions persist and can prevent women from attempting to become prégnant . This experience with a short series of viable fetuses of women with autoimmune diseases is therefore encouraging and deserves to be continued.

[About a Case of Febrile Gastroenteritis Due to Strongyloidiasis in a Gabonese Patient Treated for Lupus]. / A propos d'un cas de gastro-entérite fébrile due à une anguillulose chez une patiente gabonaise traitée pour un lupus.

Srongyloidiasis can sometimes be a source of diagnostic wandering in a patient with an autoimmune disease living in a tropical environment, despite systematic deworming with albendazole (400 mg/day/3 days), prior to the starting of a corticotherapy. We report an observation of a febrile gastroenteritis complicated by signs of intra and extracellular dehydration, in a 37-year-old lupus patient, including duodenal biopsies, and stool parasitology, which led to the diagnosis of strongyloidiasis effectively treated by ivermectin per os (two doses) of 200 micrograms/kg, once every 2 weeks apart), following failure of a first 5-days course of albendazole (400 mg/day).

L'anguillulose peut parfois être source d'errance diagnostique chez un patient porteur d'une maladie auto-immune vivant en milieu tropical, et ce malgré un déparasitage systématique par l'albendazole (40 mg/jour / 3 jours), avant la mise en route d'une corticothérapie. Nous rapportons une observation de gastroentérite fébrile, compliquée de signes de déshydratation intra et extracellulaire, chez une patiente lupique de 37 ans, dont les biopsies duodénales, et la parasitologie des selles ont conduit au diagnostic d'anguillulose traitée efficacement par ivermectine per os (2 doses de 200 microgrammes/kg, en prise unique à 2 semaines d'intervalle l'une de l'autre). Ce traitement faisait suite à l'échec d'un premier traitement par 5 jours d'albendazole (400 mg/jour).

Myeloblasts and atypical bone marrow: Fortuitous discovery of the filiarial nematode loa loa in the bone marrow during a work-up for prolymphocytic T-cell leukemia.

Loiasis is a chronic cutaneous disease caused by a filarial nematode for whom humans are the only definitive host: Loa loa, an African eyeworm transmitted by Chrysops flies. The parasite is seen on blood smears, in the skin, or during its ocular migration, but rarely on a bone marrow smear. We report the case of a 57-year-old Gabonese woman whose bone marrow aspiration during a work-up for T-cell leukemia fortuitously found Loa loa filariae.

[Cardiac arrhythmias and superior vena cava syndrome revealing a Richter's syndrome]. / Troubles du rythme cardiaque et syndrome cave supérieur révélateurs d'un syndrome de Richter.

Richter's syndrome is the aggressive transformation of chronic lymphocytic leukemia in a diffuse large cell lymphoma. The locations and the clinical manifestations are varied. We report the case of a Richter's syndrome revealed by cardiac arrhythmias and superior vena cava syndrome in a patient of 78 years followed during 2 years for chronic lymphocytic leukemia.

[Two cases of probable immune restoration syndrome under antiretroviral treatment in patients treated for tuberculosis in Gabon]. / Probables syndromes de restauration immunitaire lors de la mise sous traitement antirétroviral chez des patients traités pour tuberculose: à propos de deux observations au Gabon.

Tuberculosis can be reactivated under specific treatment, as immune reconstitution inflammatory syndrome (IRIS), in HIV patients under antiretroviral treatment. We report two observations of tuberculosis exacerbation with extension to other territories (lymph node and pericarditis) occurring 3 weeks and 4 months after administration of tuberculosis treatment, with a favourable development, in absence of rehabilitation or addition of complementary therapy These observations show the necessity of increased surveillance on the short, medium and long term in patients with both treatment for tuberculosis and antiretroviral treatment.