Wegener's granulomatosis presenting as multiple bilateral renal masses: case report and literature review.

Wegener's granulomatosis (WG) is a disease of unknown etiology characterized by necrotizing granulomatous vascularitis. The upper and lower respiratory tract and kidney involvements are very common; however, its presentation as bilateral renal masses is unusual. We report a case of a 59-year-old female patient who presented with multiple bilateral renal masses. The patient presented with sinusal and ocular symptoms suggestive of WG, and positive antineutrophil cytoplasmic antibodies (c-ANCA) with an anti-PR3 pattern. Histopathologic examination of the renal biopsy specimen revealed granulomatous inflammation with vasculitis and fibrinoid necrosis. The patient management, including prednisone and cyclophosphamid, induced a marked improvement of the renal masses. This case illustrates that WG should be considered in the differential diagnosis of renal masses.

[Adult Schönlein-Henoch purpura associated with epidermoid carcinoma of the lung]. / Association purpura rhumatoïde de l'adulte et carcinome épidermoïde du poumon.

INTRODUCTION: Association between Schönlein-Henoch purpura and neoplasm can suggest the responsibility of tumour antigens in the genesis of the vasculitis. We report a new case of squamous cell carcinoma associated with Schönlein-Henoch purpura and we discuss the reality of this association. CASE REPORT: We report the case of a 50-year-old man who presents Schönlein-Henoch purpura with a purpura of lower limbs, joint involvement, gastrointestinal lesions and IgA renal mesangial deposits. The patient received three intravenous methylprednisolone pulses followed with oral corticosteroids. Six months later, while the vasculitis was in remission, the patient presented a squamous cell lung carcinoma. He was treated by chemotherapy and local radiotherapy. At the late follow-up, the neoplasm was incompletely resolved. CONCLUSION: The neoplasm could be responsible of the development of the Schönlein-Henoch purpura. The discovery of this systemic vasculitis in an elderly patient should warrant a deep screening for an occult neoplasm.

[Hypomania under corticotherapy. About 50 cases]. / Hypomanie sous corticothérapie. A propos de 50 cas.

AIM: Our study was to determine the prevalence of hypomania as a complication of corticotherapy and to discuss its clinical and etiopathogenic aspects, but also to heighten the practitioners on the importance of screening this disorder, which become easy with psychometric scales, such Angst one. Our final purpose was the secondary and tertiary prevention of this disorder, which may cause many complications. PATIENTS AND METHODS: We have applied the Angst scale of hypomania to 50 patients, aged between 18 and 80 years, and put under corticotherapy, at dose varying between 10 and 100 mg of prednisone per day. A score superior or equals 10 was taken as a sign of hypomania. RESULTS: Fourteen patients (28%), at 43.35 year of mean age, have presented an episode of hypomania under corticoids. This prevalence was more important in patients with lupus (38.89%) in comparison with other patients (21.86%). The symptomatology has begun in 12 cases (85.7% of all cases), during the first month of treatment. The average posology used varies between 60 and 100 mg of prednisone per day. CONCLUSION: The prevalence of psychiatric problems under oral corticotherapy is difficult to estimate, but is almost 15%, according to other studies. Actually, we know that this prevalence in under estimated. This underline the importance of doing an active research of these problems in patients under corticotherapy, either by direct questioning or clinical observation, or by passing appropriate questionnaires and an adapted evaluation scale, with the aim of secondary and tertiary prevention.

Coexistence of Behçet's disease with ankylosing spondylitis and familial Mediterranean fever: a rare occurrence.

Behçet's disease (BD) and familial Mediterranean fever (FMF), which are two separate diseases sharing some clinical features, may also coexist in the same patient. Further investigations are needed to understand whether this coexistence is due to either chance or geographical distribution patterns of these diseases or to common etiopathogenetic characteristics. Spondylarthritis as part of the clinical picture in these two diseases has been questioned and probably it is not a prominent characteristic of any of them. We report a 35-year-old Tunisian man who had an association of BD, FMF and Human Leukocyte Antigen (HLA) B27 positive ankylosing spondylitis. Although that spondylarthritis is an infrequent joint involvement of FMF and BD, it must be looked for in case of association of these diseases.

Membranous glomerulopathy associated with idiopathic hypereosinophilic syndrome.

Renal involvement is rarely reported and little is known about the renal morphologic changes in the idiopathic hypereosinophilic syndromes. We reported a case of a 52-year-old man with idiopathic hypereosinophilic syndrome associated with membranous glomerulopathy. The eosinophilia and the proteinuria greatly improved with corticosteroid treatment. We review the literature regarding the nephropathy of this hematologic disorder.

[Takayasu arteritis in southern Tunisia: a study of 29 patients]. / Maladie de Takayasu au sud tunisien: étude de 29 cas.

OBJECTIVES: This study aimed to assess the clinical, laboratory, and radiological features and course of Takayasu arteritis in Tunisia. METHODS: This retrospective study analyzed 29 patients with Takayasu arteritis between 1996 and 2006 who met the criteria for inclusion proposed by the American College of Rheumatology (ACR). RESULTS: The file review identified 25 women and 4 men, with a mean age at diagnosis of 35.4 years (range: 18-65 years). Our series included 93% with involvement of the aortic arch and its branches, while only 24% involved renal arteries and 21% the abdominal aorta. We had no case with cardiac or pulmonary involvement. In all, 67.7% had type I disease, 10.7% type IIb, 3.6% type IV and 25% type V. Hypertension was recorded in 38%. No tuberculosis was observed. In all, 22 patients (75.8%) had glucocorticoid treatment, and 5 (17.2%) needed immunosuppressive therapy. Two patients with renal artery stenosis had endoluminal angioplasty and four patients (13.7%) required surgical intervention. Our patients were followed for a mean period of 80 months. Disease remained stable in 18 patients (64.2%). CONCLUSION: The clinical manifestations, angiographic data and course of our patients were similar to those in other reported series. We found no relation between Takayasu arteritis and tuberculosis.