[Carcinomatous meningitis as a rare presentation of gastric cancer]. / Méningite carcinomateuse révélant un carcinomé gastrique à cellules indépendantes.

INTRODUCTION: Carcinomatous meningitis is a rare complication of gastric cancer. CASE: A 46 year-old man with an unremarkable medical history was hospitalized for treatment of suspected meningitis. Despite treatment, his clinical state rapidly worsened and he died without regaining consciousness, shortly after transfer to the ICU. Autopsy showed that he had anchorage-independent cell gastric carcinoma, with simultaneous lymphatic, pulmonary, cutaneous and meningeal metastases. DISCUSSION: The rising incidence of secondary meningeal lesions in the last two decades is probably associated with the treatment-related improvement in life expectancy. Prognosis is very grave, and median survival time is only several weeks. Carcinomatous meningitis is difficult to diagnosis, especially as the first sign of a primary tumor. This rare presentation of gastric cancer indicates diffuse metastatic spread and extremely poor prognosis.

[Acute diarrhoea revealing a coeliac disease]. / Diarrhée aiguë révélatrice d'une maladie coeliaque.

INTRODUCTION: The classical mode of revelation of a coeliac disease is chronic diarrhoea. We report the case of a patient in whom acute diarrhoea revealed the disease. OBSERVATION: In a 40 year-old man with acute diarrhoea with 7 non-bleeding stools per day, upper digestive tract endoscopy showed a villosity atrophy aspect confirmed by the histological examination. The search for specific antibodies of a coeliac disease was positive. A gluten-free diet led to the disappearance of the diarrhoea, followed by the disappearance of the specific antibodies and the regression of the villosity atrophy. COMMENTS: Acute diarrhoea that resists medical treatment must evoke the hypothesis of a coeliac disease and lead to a gastroscopy with duodenal biopsies. The interest of evoking the diagnosis is not only in order to obtain the rapid disappearance of the clinical signs after the introduction of a gluten-free diet but also to avoid an increase in the high risk of malignant lesions of the small intestine.