Myocarditis associated with campylobacter jejuni colitis: a case report.

Myocarditis is a rare complication of acute diarrhea due to Campylobacter Jejuni infection. We present the case of 25-year-old male who presented with campylobacter jejuni colitis who subsequently had chest pain and elevated cardiac biomarkers. The patient developed acute myocarditis confirmed on cardiac magnetic resonance imaging.

[Electrocardiographic and echocardiographic abnormalities in patients with cirrhosis due to viral hepatitis B: about 60 cases reported in the Hepatogastroenterologic Department at the Aristide Le Dantec Hospital in Dakar (HALD)]. / Anomalies électrocardiographiques et échocardiographiques au cours de la cirrhose virale b: à propos de 60 cas au service d'hepato-gastroenterologie de l'Hopital Aristide Le Dantec de Dakar (HALD).

This study aimed to evaluate the electrocardiographic abnormalities in patients with cirrhosis due to viral hepatitis B and to identify their determinants. We conducted a prospective study in the Hepatogastroenterologic Department and in the Department of Cardiology at the Aristide Le Dantec Hospital in Dakar over a period of 8 months. All patients with cirrhosis due to viral hepatitis B and without a history of heart disease were included in the study. We collected and analyzed the epidemiological, clinical, echographic, endoscopic, electrocardiographic, echocardiographic (2D and Doppler) data and laboratory data from all patients. Sixty patients were enrolled. The prevalence of cirrhosis due to viral hepatitis B was 3.4%. The average age was 41 years and the sex-ratio was 1.6 (37 men). Cirrhosis was classified as Child-Pugh B in 29 patients (49%), Child-Pugh C and Child Pugh A in 20 patients (33%) and 11 patients (18%) respectively. The most common electrocardiographic abnormalities included left ventricular hypertrophy and QTc interval prolongation detected in 27 patients (45%) and 24 patients (40%) respectively. Statistical analysis showed an association between prolonged QTc interval and the severity of cirrhosis (p = 0.01, RR = 2, CI = 0.24 - 0.341). Echocardiographic abnormalities were dominated by left ventricle dilatation (58.3%) and cardiac hyperoutput (43.3%), with an average output of 6.05 l/ min. Statistical analysis revealed a significant association between cirrhosis severity and cardiac hyperoutput (p = 0.003; CI: 95%, 2,883-38,58; RR = 2). A total of 14 patients (23.3%) had latent cirrhotic cardiomyopathy. Cirrhosis due to viral hepatitis B can cause a wide range of different cardiac abnormalities. These include morphological and/or electrophysiological abnormalities whose severity appears to be correlated with cirrhosis severity.

[An unusual cause of jaundice]. / Une cause inhabituelle d'ictère.

Hepatic impairment is common during hyperthyroidism. It is most often asymptomatic. Hyperthyroidism revealed by jaundice has been rarely described in the literature. We here report the case of a 52-year old patient in Dakar (Senegal) presenting with jaundice associated with pruritus. Laboratory tests showed elevated alanine aminotransferases (1.1 N), aspartate aminotransferase(1.5 N), alkaline phosphatases (3 N), gamma glutamyl transferases (1.3 N) and bilirubinemia (22 N). Abdominal ultrasound was normal. A toxic or drug-related cause, bile duct obstruction, viral or autoimmune hepatitis as well as primary biliary cholangitis were excluded. The dosage of thyroid hormones showed elevated free T4, 24 ng/dL (9-20 ng/dL) and undetectable plasma TSH less than 0.01µUI/mL (0,35-4,94 IU/mL). TSH receptor antibodies were positive 7.04 IU/L (n < 1.75 IU/L). Thyroid ultrasound objectified diffuse homogeneous hypervascular goiter. The diagnosis of hepatic impairment secondary to Graves-Basedow disease without cardiac dysfunction was retained. Clinical outcome and laboratory test results were favorable under carbimazole. Jaundice can be an indicator of hyperthyroidism. An investivation of clinical signs and laboratory parameters for hyperthyroidism is essential in patients with unexplained jaundice.

[Viral Hepatitis B: clinical, paraclinical and evolutionary features within the Hepatogastroenterology Department at the Aristide Le Dantec Hospital: about 728 cases]. / Hépatite virale B: aspects cliniques, paracliniques et évolutifs dans le service d'Hépato Gastroentérologie de l'Hôpital Aristide Le Dantec: à propos de 728 cas.

Viral Hepatitis B is a major public health problem in sub-Saharan Africa accounting for approximately 65 million of chronic carriers and 56.000 deaths per year. Our study aims to investigate the epidemiological paraclinical, therapeutic and evolutionary features of viral hepatitis B in patients followed up in our Department and to describe their serological profiles. We conducted a retrospective, longitudinal study in the Hepatogastroenterology Department at the Aristide Le Dantec Hospital in Dakar from 2010 to 2014. We included all HBsAg positive patients followed up on an ambulatory basis or hospitalized. We collected data from 728 medical records of patients infected with Hepatitis B virus: 7 cases of acute hepatitis, 442 cases of chronic infections, 161 cases of cirrhosis and 118 cases of hepatocellular carcinoma. The average age of patients was 33 years [14 - 83 years] with a sex ratio of 2.2. The circumstances in which it was diagnosed included systematic screening (26.2%), right hypochondrium pain (23%) and donation of blood (18.6%). Fifty nine were Hepatitis B virus mono-infected and had chronic active hepatitis. Inactive carriers were 118. Serological status was undetermined in 252 patients due to clinical examination inadequacy related to economic constraints. Antiviral Hepatitis B treatment wasn't performed in 58 patients. Patients' virologic and biochemical response after 120 weeks of treatment with Tenofovir was 85% and 100% respectively. Hepatitis B virus is a major cause of liver disease in Senegal.

[Costal metastasis revealing esophageal squamous cell carcinoma]. / Métastase costale révélant un carcinome épidermoïde de l'œsophage.

Esophageal cancer is associated with poor prognosis. Its severity is linked to delayed diagnosis which is most often made once a cancer has metastasized, in Africa. Costal metastases are rare. We report a case of a 38-year old Senegalese patient with squamous cell carcinoma of the lower esophagus with lytic metastases to the ribs. Mrs. TD, aged 38, was admitted with painful swelling in right hemithorax associated with weight loss. The patient also reported mechanical dysphagia evolving during 4 months which had not motivated consultation. Clinical examination showed a poor general condition, a hard, sensitive swelling measuring 3 cm along its longer axis, located on the anterolateral surface of the right hemithorax at the level of the 5thrib. Biological examinations showed normocytic normochromic anemia with hemoglobin level of 9.4 g/dl, non-specific biological inflammatory syndrome, and hypercalcemia (corrected calcium = 107 mg/l. Oesogastroduodenal endoscopy showed a ulcerative, budding, stenotic lesion 32 cm from the dental arches. Anatomopathological examination of the biopsies revealed moderately differentiated squamous cell carcinoma. In addition to oesophageal tumor, thoracoabdominal-pelvic computed tomography showed bone lysis involving the anterior arch of the 5th rib, carcinomatous pulmonary nodules and bilateral pleural effusion. Pleural fluid aspiration through an exploratory needle showed serohematic fluid and the cytological examination of this fluid objectified carcinomatous cells. The diagnosis of squamous cell carcinoma of the lower esophagus with rib, pleural and pulmonary metastases was retained and palliative treatment was initiated. The evolution was marked by the death of the patient 3 months after gastrostomy, within a context of respiratory distress. The originality of this observation is related to the atypical seat of metastases of this cancer of the esophagus as well as the risk factors of this tumor. Cancer of the esophagus in young adults is a major problem in Africa. The challenge is to determine its risk factors in order to prevent its occurrence.