Pulmonary Infection Caused by Mycobacterium malmoense in a Chronic HIV-Infected Individual Participating in a Therapeutic Vaccine Trial.

We report a case of Mycobacterium malmoense pulmonary infection and HIV-1 chronic co-infection in a 60-year-old man while participating in an HIV-1 therapeutic vaccine clinical trial and during the analytical treatment interruption. We present clinical and therapeutic features of a complicated M. malmoense pulmonary infection along with discussion of the possible relation to the HIV-1 cure-related interventions.

Behçet's Disease and Tuberculosis: A Complex Relationship.

Behçet's disease (BD) is a systemic vasculitis characterized by recurrent orogenital ulceration and several systemic manifestations (such as gastrointestinal involvement, vascular disease or arthritis). The pathogenesis is still unknown but the trigger role of certain pathogens such as Mycobacterium tuberculosis is well documented. Furthermore, patients with BD are more susceptible to tuberculosis due to immunity defects. Here, we describe the case of a 70-year-old woman with a history of recurrent oral aphthae and inflammatory arthritis presenting with extensive thrombosis of left upper limb major veins, a positive HLA B51 genotype and colon ulceration; hence, BD diagnosis was made after excluding other causes. Simultaneously, the patient had cutaneous abscesses not associated with immunosuppressive therapy with continuous development, and after recurrent negative tuberculosis work-up, M. tuberculosis was isolated in an abscess culture. LEARNING POINTS: Patients with Behçet's disease (BD), in the absence of anti-TNF-alpha therapy, have increased susceptibility to tuberculosis due to a defect in cell-mediated immunity.It is very important to distinguish between BD and pseudo-Behçet's at the onset of tuberculosis, since Behçet-like manifestations achieve complete remission with anti-bacillar therapy.Cutaneous tuberculosis is a rare condition, with a wide clinical spectrum; hence, high clinical suspicion, and sometimes, multiple bacteriological examinations, are required in order to diagnose.

Hyperglycaemic Hemichorea.

BACKGROUND: Hyperkinetic disorders such as hemichorea can be caused by cerebrovascular, infectious or inflammatory diseases or by metabolic conditions such as hyperglycaemia. Hyperglycaemic hemichorea is a rare movement disorder which is frequently misdiagnosed. It is characterized by involuntary, continuous, non-patterned movements on one side of the body, basal ganglia lesions seen on head CT or MRI, and clinical improvement after blood glucose normalization. We describe the case of a female patient with uncontrolled diabetes who presented with hemichorea. CASE PRESENTATION: We report the case of a 69-year-old woman with type 2 diabetes who presented with abnormal movements of the right upper limb. She had no neurological signs other than hemichorea. Her blood glucose level was 349 mg/dl and her glycosylated haemoglobin level (HbA1c) was 10.5%. Head CT and MRI showed no changes in the basal ganglia or ischaemic lesions. The patient was started on insulin and haloperidol with clinical improvement. CONCLUSION: Larger case series are needed to establish better understanding of the physiopathological mechanisms and diagnostic criteria of hyperglycaemic hemichorea. The most important diagnostic criterion is clinical improvement after glycaemic control. LEARNING POINTS: Hyperglycaemia is a rare cause of hemichorea.Better understanding of the physiopathology and the establishment of diagnostic criteria are required.Correction of the underlying hyperglycaemia will lead to rapid improvement of the movements and is the most important feature for diagnosis.