Symptomatic hypercalcemia and lytic lesions of the skull revealing sarcoidosis: A case report.

Sarcoidosis is a systemic granulomatosis of unknown etiology. Mediastinal lymph node and pulmonary involvement are the most characteristic manifestations. However, bone involvement is rare during sarcoidosis. Herein, we describe an atypical case of sarcoidosis revealed by a severe hypercalcemia and lytic lesions of the skull without pulmonary or mediastinal manifestation. A 53-year-old woman was admitted for symptomatic hypercalcemia of 3.8 mmoL/L. The initial good course after hydration combined with a dose of intravenous zoledronate was followed by a relapse of hypercalcemia. Computed tomography (CT) scan showed 2 lytic lesions of the skull and multiple nodules and micronodules in the liver and the spleen which were of normal size. The histological examination showed a non-necrotizing granulomatous hepatitis, with no signs of malignancy. The bone marrow biopsy did not show any abnormality. Assessment for tuberculosis was negative. The diagnosis of sarcoidosis was considered. Oral prednisone therapy allowed total remission.

Focal pyomyositis caused by Enterobacter in an immunocompetent patient: A case report.

Pyomyositis is a pyogenic infection of skeletal striated muscle, usually found in tropical areas, often in immunocompromised patients. We report a new observation of a nontropical Enterobacter pyomyositis occurring in an immunocompetent female in Tunisia. A 53-year-old patient presented with acute fever and intense myalgia in the right thigh. On clinical examination she had an altered general condition, a fever at 40°C and an important swelling of the lateral side of the right thigh. In biology, she had an inflammatory syndrome. Blood culture had identified Enterobacter. Muscle magnetic resonance imaging showed diffuse inflammatory involvement of the vastus lateralis muscle of the right quadriceps associated with edematous infiltration of subcutaneous fatty tissues. Diagnosis of pyomyositis was retained. Antibiotic therapy initially probabilistic and then adapted to the antibiogram was initiated with a favorable outcome. Although rare outside the tropics, the potential severity of pyomyositis encourages its better knowledge.

Comparative Study for Surgical Treatment of Acute Distal Tibiofibular Syndesmotic Lesions Using the Modified Suture-Button Fixation Versus Static Syndesmotic Screw Fixation.

INTRODUCTION: Several techniques to treat acute distal tibiofibular instability are described consisting in static and dynamic fixation procedures. The aim of our work is to compare the outcomes of acute syndesmotic injury fixation between the modified technique of dynamic fixation using the suture-button principle as an efficient and low-cost method and the classic static fixation. METHODS: It is a prospective study including patients presenting with acute syndesmotic injury. After fracture fixation, residual syndesmotic instability was managed using syndesmotic screw in group A and dynamic fixation with a double Ethibond suture in group B. Functional results were assessed using the American Orthopaedic Foot and Ankle Society score (AOFAS) score. Radiological evaluation was done by a postoperative computed tomography (CT) scan of both ankles and plain X-rays of the ankle after surgery and at 18 months. RESULTS: Group A included 20 patients meanwhile 35 patients were in group B. The reduction was satisfactory in the 2 groups according to the postoperative CT scan measurements. The mean healing time in group A was 49.65 days and 51.49 days in group B (P = .45). We did not find any significant difference in terms of loss of reduction in the 2 groups. The return to work was faster in group B (P = .04). Patients in group B had better AOFAS score (P = .03) and ankle range of motion than those in group A. The difference was statistically significant (P = .02 for dorsal flexion and P = .001 for plantar flexion). For group A, we did not note any early complications. Meanwhile, 7 patients developed skin complications in group B (P = .03). However, no significant difference was found in terms of late complications. CONCLUSIONS: The modified dynamic suture-button fixation remains a therapeutic alternative in low-income countries that could achieve better outcomes than static fixation, with easy postoperative follow-up. LEVELS OF EVIDENCE: Level II.

An unusually aggressive multiple non-ossifying fibroma of the distal tibia and fibula: A case report.

Background and purpose: Non-ossifying fibroma (NOF) is one of the most commonly seen benign bone tumours. Although renowned for their benign behaviour and tendency for spontaneous healing, these tumours can occasionally exhibit an aggressive course. Few published papers have focused on the treatment options of symptomatic NOFs.The aim of this case report is to discuss the clinical presentation of a painful and unusually aggressive multiple NOF of the distal tibia in a female adolescent patient. Case presentation: The case of a 17-year-old female patient who was complaining of a painful swollen right lower leg for the past few months. The symptoms became gradually worse, preventing her from sporting activities and becoming more and more debilitating. The patient was diagnosed with a particularly aggressive multiple non-ossifying fibroma of the distal tibia and fibula. She was treated with lesion curettage, bone grafting and external fixation with good clinical and radiological outcomes. Conclusion: Non-ossifying fibroma is a benign lesion that only requires observation in most of the cases. However, symptomatic lesions with aggressive behaviour or complicated with pathologic fracture may warrant surgical intervention.

Unusual case of lateral subtalar joint dislocation associated with calcaneal fracture and lateral malleolus fracture.

Introduction: Subtalar dislocation is defined by a simultaneous total separation of the talocalcaneal and talonavicular joints. Lateral variety is the rarest. It is the result of a high energy trauma. It occurs following forced eversion, with the foot locked in a rut with pressure on the lateral aspect of the leg. Articular fractures of the calcaneus occur as a result of axial impact on the greater tuberosity.We report the case of a lateral subtalar dislocation associated with a calcaneal fracture. Case presentation: A 62-year-old man who presented to the emergency room following a 9 m fall. Initial examination revealed a swelling of the right foot and ankle with a deformity giving the appearance of a "flat foot" without skin opening. The neuro-vascular examination was normal.A radiological assessment including an antero-posterior and lateral X-ray of the right ankle and a axial view if the calcaneus, showed a calcaneal articular fracture and a lateral dislocation of the subtalar joint. CT scan confirmed the diagnosis. Closed reduction by external maneuvers failed. Through a lateral mini-approach centered on the subtalar joint, open reduction of the dislocation was achieved and controlled fluoroscopically. Osteosynthesis of the calcaneal fracture was performed using a percutaneous pinning. Consolidation was obtained at 3 months post-operatively.At the last follow-up, the patient reported occasional pain. The radiological assessment showed early arthritic changes of the subtalar joint. Conclusion: In rare cases of subtalar dislocation, the direction of displacement, associated bone injuries, and open reduction would be responsible for a poor functional outcome. At present, there is no certain way to avoid subtalar osteoarthritis.

Gastrointestinal bleeding due to jejunal metastasis of pleomorphic lung carcinoma: a case report.

Gastrointestinal metastasis of pleomorphic lung cancer presents with nonspecific manifestations, leading to delayed diagnosis. Herein, the authors report the case of a 56-year-old patient who presented with gastrointestinal bleeding due to pleomorphic lung carcinoma. Case presentation: A 56-year-old patient presented to the emergency department with melena. On examination, he was hemodynamically stable. He had a sensitive and mobile mass in the periumbilical region. A thoracoabdominal computed tomography scan showed a mass of the right apical superior lobe measuring 4 cm and a lobulated jejunal mass measuring 10 cm. A percutaneous biopsy of the lung tumor revealed primary pleomorphic lung carcinoma. The authors performed a midline laparotomy and made a bowel resection with an end-to-end anastomosis. The postoperative course was marked by severe nosocomial pneumonia, leading to septic shock and death. The histopathologic examination concluded with a metastatic lesion of pleomorphic lung carcinoma. Clinical discussion: The authors reported a rare case of jejunal metastasis of pleomorphic lung cancer. Pleomorphic carcinoma of the lung is a rare pathology that accounts for 0.1-0.4% of nonsmall-cell lung cancer. The prognosis is poor. In the presence of gastrointestinal bleeding caused by small bowel metastases of pleomorphic lung cancer, surgery is the treatment of choice. Conclusions: Small bowel metastasis of pleomorphic lung cancer is rare. Surgical treatment is the treatment of choice. The authors highlight the importance of suspecting gastrointestinal metastases in patients with pleomorphic lung cancer in the presence of nonspecific digestive symptoms.

Intraperitoneal migration of hydatid cyst of the liver with intact proligerous membrane: Hydatid delivery.

•Intra-peritoneal migration of hydatid cysts is a rare complication.•Intact proligerous membrane is a protective factor.•Surgery is the best treatment and should be performed timely.

A "happy ending" of mediastinal and abdominal lymphadenopathy associated with hepatosplenomegaly and pulmonary lesions.

Major diagnosis for mediastinal and abdominal lymphadenopathy is lymphoma and tuberculosis. Spontaneous remarkable evolution should discuss viral infection on the condition that no corticosteroids have been taken before as they could magically improve an authentic lymphoma. Trial of antituberculosis treatment that is used in some cases could lead to a misdiagnosis as the viral-infected patient can spontaneously heal as it is described in this case.