Transient adult T-cell leukemia/lymphoma picture during varicella infection in an HTLV-1 carrier.

HTLV-1 (human T-lymphotropic virus type 1) is associated with tropical spastic paraparesis, adult T-cell lymphoma (ATL), and also with opportunistic infections. The risk for developing ATL in HTLV-1 healthy carriers is low, between 1 and 4%. Nothing is known about the events promoting the evolution from the healthy carrier state to symptomatic ATL. We describe the case of a 44-year-old French Caribbean man with a chronic and recurrent strongyloidiasis in which the occurrence of a hemorrhagic and necrotic varicella led to the discovery of an infection by HTLV-1 and an acute form of ATL. All hematological data were normal before the onset of varicella. ATL completely disappeared at the same time as the varicella healed. This leads us to hypothesize that acute infections such as the reactivation of varicella-zoster may act as a promoting factor for the development of ATL in healthy HTLV-1 carriers.

[Primary intramedullary spinal cord lymphoma in HIV patients. MRI aspects]. / Lymphome intramédullaire primitif (LIMP) en dehors de l'infection par le VIH. Aspects en IRM.

We report a case of an immunocompetent man who developed primary spinal intramedullary malignant lymphoma. This condition occurs in about 0.9 p. 100 of primary central nervous system non-Hodgkin lymphomas in non-AIDS patients. Magnetic resonance imaging was nonspecific but suggestive. Like the brain localization, prognosis is poor. Because of the high frequency of recurrence, usually confined to the central nervous system with neuraxis dissemination, treatment must be delivered to the entire neuraxis. But more effective treatment strategies with radiotherapy-chemotherapy combinations will be needed. Feasibility and toxicity patterns remain to be determined.

[Olfactory esthesioneuroma manifesting as Schwartz-Bartter syndrome]. / Esthésioneurome olfactif révélé par un syndrome de Schwartz-Bartter.

INTRODUCTION: Olfactory esthesioneuroblastoma is an uncommon neuroectodermal tumor originating from the olfactory epithelium, which is rarely associated with hormone excess syndrome. EXEGESIS: Asymptomatic olfactory esthesioneuroblastoma was diagnosed in a 22-year-old man who presented a syndrome of inappropriate antidiuretic hormone secretion. Following surgery, the immunohistochemical analysis demonstrated the existence of neurophysin hormone in tumoral cells. CONCLUSION: This case provides evidence that olfactory esthesioneuroblastoma can be uncovered by inappropriate antidiuretic hormone secretion.

[Bacterial cerebral aneurysms without infectious endocarditis: analysis of a case and review of the literature]. / Les anévrismes bactériens cérébraux sans endocardite infectieuse: étude d'un cas et revue de la littérature.

INTRODUCTION: Bacterial intracerebral aneurysms, which are a common complication of infectious endocarditis, are unusual without Osler's disease. EXEGESIS: From the case report of a man with a bilateral bacterial intracranial aneurysm without endocarditis resulting in an hypopituitarism, we undertook a literature review of bacterial intracerebral aneurysms without endocarditis. CONCLUSION: Although this review has found few cases, this kind of aneurysms seems to have different features from those secondary to infective endocarditis: younger age of incidence, majority of Staphylococcus aureus, clinical presentation as a thrombophlebitis of the cavernous sinus, location of aneurysm on bigger cerebral artery.

[Hepatic amebiasis in France. Apropos of 152 case reports]. / L'amibiase hépatique en France. A propos de 152 observations.

The authors report upon 152 cases of hepatic amebiasis (H.A.) observed in France between 1969 and 1983, among young european men (average age 29,2) who were hospitalised in the initial phase of their illness. H.A. was clinically revealed through a painful and febrile hepatomegaly in 3/4 cases and in 6 cases through complications. No chronic form was observed. The amebic serology (I.F.I. and/or H.A.P.) was always positive. The research of an intestinal portage of the parasite was generally negative. The hepatic functions were impaired in the third of the cases. Whichever technique was employed, the anatomic diagnosis has always been made in a phase of intra hepatic collection. The superiority of echotomography over other methods is confirmed (especially for diagnosis of multiple abscess: 47% of success). All patients recovered, most frequently through medical treatment (117 cases). The nitro-imidazoles (1,5 to 2 g per day during 7 to 14 days) remain the prefered treatment, but they are responsible for 5 failures which were overcome by emetine. On the other hand, 4 patients had, after being cured, showed middle and long term relapses without patient recontamination. The evolution of the treated H.A. is significantly correlated to the importance and/or the multiplicity of the liver collection: the voluminous abscess of the right lobe being the most potentially dangerous. The pathogenesis of the H.A. remains imperfectly known. The different clinical aspects which have been found, depend upon the preexistant immunity of the patient and could also be equally associated with a pathology of complex immunity systems.

[Severe algodystrophy of the foot simulating ischemic arteriopathy. Spectacular cure by regional sympathetic block with guanethidine]. / Algodystrophie sévère du pied simulant une artériopathie ischémique. Guérison spectaculaire par bloc sympathique régional à la Guanéthidine.

The authors report a case of severe algodystrophy of the foot complicating a typical episode of algodystrophy of the knee, and which resulted in appearances of acute ischaemia of the foot. Paraclinical investigations seemed to support this aetiology but arteriography excluded this diagnosis, showing only regular distal arterial narrowing. This case illustrates the extremely variable clinical and paraclinical features of algodystrophy and the possibility of significant hypofixation from the onset and during the course of algodystrophy in young patients. It shows that there are no specific, constant clinical signs or paraclinical changes. From the therapeutic point of view, it confirms the often spectacular effects of prolonged regional sympathetic nerve block with Guanethidine which may give an immediate and definitive cure of severe algodystrophy when all else has failed.