[Purple extremities in black-skinned patients: blue toe syndrome as presenting sign of antiphospholipid antibody syndrome]. / Extrémités violettes sur peau noire: orteils pourpres révélateurs d'un syndrome des antiphospholipides.

Although acral ischemia can involve several underlying mechanisms, suspicion of lupus warrants testing for antiphospholipid antibodies in patients with blue toe syndrome.

[Castleman's disease: first case in Gabon]. / Maladie de Castleman: première observation au Gabon.

Castleman's disease is an atypical lymphoproliferative disorder characterized by hyperplasia of lymphoid structures with vascular proliferation. It has rarely been diagnosed in black African populations. The purpose of this report is to describe the first case in Gabon. The patient was a 47-year-old black African man. Outcome was fatal.

[Kikuchi-Fujimoto disease in Gabon. Description of first 2 cases in Gabon]. / Maladie de Kikuchi-Fujimoto: 2 premiers cas au Gabon.

Kikuchi-Fujimoto disease is a rare disorder sometimes associated with systemic lupus. It has rarely been reported in the black African population. The purpose of this report is to describe the first two cases in Gabon. In patients presenting enlarged cervical lymph nodes, it is first necessary to rule out infectious disease. Histology can allow diagnosis by demonstrating necrotizing histiocyte lymphadenitis.

[Lupus, corticosteroid treatment and opportunistic infection: 26 cases in Gabon]. / Corticothérapie et infections opportunistes dans une cohorte de 26 lupus au Gabon.

Opportunistic infection is frequent in lupus patients. Susceptibility is inherent in the lymphopeniant nature of the disease and enhanced by the use of immune-suppressing agents (alone or in combination) for optimal disease control. The purpose of this retrospective series of lupus patients diagnosed based on the criteria of the American College of Rheumatology (ACR) was to assess the frequency of opportunistic infection in a high-risk epidemiological area. A total of 26 patients (24 women, 2 men) with a mean age of 28.8 years were identified. Systematic review carried infectious before the steroid and in light of the local endemicity (HBs Ag, hepatitis C serology, HIV + Rx Thorax IDR) coupled with blood cultures was non-contributory, without waking the tank or during the introduction treatment. With a mean follow-up of 3.6 years (range, 0.83 to 9.91), only one case of tuberculosis was observed with fatal outcome. Our study indicates that the prevalence of opportunistic infections in the Lupus under treatment in a high-risk area for infectious diseases was low. This finding suggests that the risk of infectious complications secondary to corticosteroid therapy in sub-Saharan zone is acceptable provided that surveillance is performed on a regular basis.

[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.

[Evaluation of the cost of managing systemic lupus erythematosus in Gabon]. / Evaluation du coût de la prise en charge du lupus érythémateux disséminé au Gabon.

The purpose of this retrospective study was to evaluate the cost of managing systemic lupus erythematosus in Gabon. Study was carried out from 01/2004 to 12/2007. All patients presenting at least 4 of the 11 diagnostic criteria of the American College of Rheumatology were included. The total cost was calculated for the first year and from the second year. A total of 25 patients (24 women, 1 man) with a mean age of 29.6 years (range: 18 and 45) were included in the study. Care was provided by the patient her/himself (n = 8), parents (n = 11), or jointly by other relatives (n = 6). The average cost of accommodation was euro 769.6. Diagnostic review and impact cost were euro 53.3 and euro 58.6 respectively. Overall the average cost of hospitalization was euro 972.7. The total cost for the first year following diagnosis was 1398.6 for patients with the cutaneous-articular form of systemic lupus erythematousus and euro 1500.7 for patients with visceral forms. From the second year on, the annual cost was euro 261 for patients with the cutaneous-articular form and euro 534.7 for patients with visceral forms. Sixteen of the 25 patients were regularly re-examined as outpatients. Nine patients were lost to follow-up including 5 during the first year, 3 during the second year, and 1 during the third year. Two deaths occurred due to chronic renal failure and septic shock. This study shows that long-term follow-up for systemic lupus erythematosus in Gabon is difficult due to patient dropout.

[Dermatomyositis and pregnancy: a case in Gabon]. / Dermatomyosite et grossesse: une observation au Gabon.

The purpose of this report is to describe a case of successful pregnancy involving a 30-year-old Afican woman presenting dermatomyositis, without use of immunosuppressive treatment. The child was delivered prematurely by caesarean section at 32 weeks of gestation.

Non-adherence to antiretroviral therapy in patients infected with HIV and cryptococcal meningitis: two cases at the Lambaréné Hospital Center in Gabon.

Cryptococcal meningitis is a serious infection occurring mainly in immunodepressed patients, especially those with AIDS. Its incidence is growing among people living with HIV/AIDS who interrupt their antiretroviral treatment. We report two cases that occurred in this situation and had lethal outcomes in the short term. Testing for cryptococcal antigen in serum (serum CRAG test) enables a reliable and early diagnosis, and its use should be promoted in rural areas of sub-Saharan Africa.

Assessment of Imatinib in the treatment of chronic myeloid leukemia in Gabon: a cohort of 17 cases.

The prognosis for chronic myeloid leukemia, the first hematologic malignancy for which successful targeted therapy has been developed, has changed markedly in the West. In developing countries, however, prognosis remains poor, mainly because of lack of access to treatment. The effort made by some nongovernmental organizations to distribute first-generation tyrosine kinase inhibitors free of charge has changed this situation in some regions, notably in sub-Saharan Africa and Gabon in particular. We report the results in a cohort of 17 patients.

[First clinical and serological description of leptospirosis in Gabon]. / Première description clinique et sérologique de la leptospirose au Gabon.

We report the first case of leptospirosis describe in Gabon. Several environmental factors could favour the transmission of the disease in that country.

[Prevalence of hepatitis B and C virus, HTLV-1 and HIV in type B lymphoproliferative syndromes in Gabon]. / Prévalences des virus des hépatites B et C, de l'HTLV-1 et du VIH dans les syndromes lymphoprolifératifs de type B au Gabon.

B lymphoproliferative disorders (B-LPD) are the most frequent types of lymphoid malignancies encountered in Gabon where HCV, HBV, HTLV-I and HIV are highly prevalent and all known for lymphotropism. Prevalences of HBs Ag, antibodies to HCV, HTLV-I and HIV were compared in 40 patients (21 men, 19 women; 17 < age < 75 years) with newly diagnosed B-LPD (low grade lymphoma = 6, intermediate grade = 21, high grade = 8: chronic lymphocytic leukaemia = 5) and 160 age and sex-matched controls. None of the B-LPD patients had got transfusion or parenteral care from the onset of symptoms to the inclusion day. In the B-LPD group, 13 patients had HBs Ag and antibodies to HCV, HIV and HTLV-1 were detected in 11, 6 and 10 subjects. In monovariate analysis, HBs Ag, antibodies to HIV or HTLV-1 were risk factors for B-LPD but antibodies to HCV were not associated with such diseases. Multivariate analysis showed only a relationship between HBs Ag and B-LPD (OR = 3.86; IC: 1.11-13.48). In such patients, reactivation of B hepatitis by treatment of B-LBD may be an important concern. If a background poor immune system could explain both susceptibility to long standing virus carriage and lymphoma development, a participating action of the HBV in lymphomagenesis could not be excluded.

[Types of sugar diabetes encountered in internal medicine in Gabon]. / Typologie des diabètes sucrés rencontrés en medecine interne au Gabon.

In the 108 patients with diabetes (75 men and 33 women between the ages of 15 and 86 years) hospitalized in the Internal Medicine Department of the Libreville Hospital Center between January 1, 1989 and December 31, 1991, 53 were easily classified, 12 being due to alcohol-induced chronic calcific pancreatitis, two to insulin-dependent diabetes, and 39 to non-insulin-dependent diabetes. Fifty-five patients treated with insulin were not immediately classifiable including 11 who were obese and probably should not have required insulin. In the remaining 44 patients who were not overweight, the youngest often presented features comparable to those observed in patients with chronic calcific pancreatitis except with regard to calcification. Most of the older patients were women in whom diagnosis was coincidental. These findings indicate that authentic insulin-dependent diabetes is uncommon, that non-insulin-dependent diabetes are frequent, and that the endocrine pancreas is particularly susceptible to alcohol abuse.

[Mycosis fungoides in a Gabonese patient infected with HTLV-I]. / Mycosis fongoïde chez une gabonaise infectée par le HTLV-I.

Association of human T-lymphotropic virus type-1 (HTLV-1) with T-cell malignancy is well-known but its relationship with mycosis fungoides is controversial. Typical mycosis fungoides was diagnosed at tumor stage in a 58-year-old Gabonese woman also infected with HTLV-1. Infection with lymphoma of the skin is uncommon in Africa but it is probably underestimated. Association of mycosis fungoides with retrovirus infection could be coincidental since there is a high prevalence of HTLV-1 in Gabon and the only currently recognized association is T-cell leukemia/lymphoma. However recent data indicate the presence of similar retrovirus particles and a common tax gene in the monocytes of most patients presenting mycosis fungoides.

[Epidemiology of upper gastrointestinal bleeding in Gabon]. / Profil épidémiologique des hémorragies digestives hautes au Gabon.

The department of internal medicine of the military hospital of Gabon managed 92 cases of upper gastrointestinal bleeding from April 2009 to November 2011. The frequency of these hemorrhages in the department was 8.2%; they occurred most often in adults aged 30-40 years and 50-60 years, and mainly men (74%). Erosive-ulcerative lesions (65.2%) were the leading causes of hemorrhage, followed by esophageal varices (15.2%). These results underline the importance of preventive measures for the control of this bleeding.

[Socioeconomic aspects and management of chronic hepatitis B and C in Libreville, Gabon]. / Aspects socioéconomiques de la prise en charge des hépatites chroniques B et C à Libreville (Gabon).

INTRODUCTION: Viral hepatitis remains a major public health problem in the sub-Saharan region. Diagnosis is often made at an advanced stage after a long period with few or no symptoms. Late diagnosis impedes optimal management. MATERIALS AND METHODS: All patients treated for documented chronic hepatitis B or C from January 2001 to December 2009 were identified and the cost of their treatment was estimated. Data examined included socioeconomic information, circumstances surrounding diagnosis, cost of work-up, cost of curative treatment (pegylated interferon + ribavirin for hepatitis C and lamivudine for hepatitis B), and overall cost of support. RESULTS: The study included 146 patients (65 women, 81 men) with a mean age of 34 years. Hepatitis was type B in 89 patients, type C in 51, and type B/C coinfection in 6 patients. The estimated cost of work-up was 483 USD for type B and 507 USD for type C. The cost of curative treatment was 1569 USD for type B and 7842 USD for type C. The estimated cost of support was 407 USD. The total cost of management was 2459 USD for type B and 8757 USD for type C. Only 9 patients received optimal treatment, and it resulted in curing 3 of the 4 with hepatitis B and 4 of the 5 with hepatitis C. During treatment, progression to cirrhosis occurred in two patients, one with hepatitis B and one with hepatitis C. CONCLUSION: Financial constraints frequently prevent patients in Gabon with hepatitis B and C from receiving optimal care. The creation of a national healthcare system in 2008 may lead to cost reductions and improve management of this disease in a predominantly young population.

[Association myositis and hepatocellular carcinoma: one case and review of literature]. / Association myopathie inflammatoire et hépatocarcinome : à propos d'une observation et revue de la littérature.

Association inflammatory myopathies and tumors are not fortuitous but association with hepatocellular carcinoma is rarely reported in literature. We described a case of association polymyositis hepatocellular carcinoma in 37-year-old black African patient, with fatal issue.