RESUMEN
Since the improvement in management and the reduction of mortality caused by the disease activity, infections have represented the main cause of morbidity and mortality in systemic lupus erythematosus patients. We aimed to determine the prevalence and identify risk factors of severe infections in systemic lupus erythematosus patients. We conducted a retrospective study on 93 Tunisian lupus patients followed between 2010 and 2019. The mean age of the disease was 33.63 ± 13.76 years. Fifty-two patients had 118 infections and 16% of the infections were serious. The bivariate analysis revealed a positive correlation between the total cumulative doses of corticosteroids and the number of serious infections (p = 0.009). The multivariate study has shown that the number of flares (p = 0.03), pulmonary manifestations (p = 0.01), pleuritis (p = 0.001), and the total cumulative dose of corticosteroids (p = 0.04) were independent risk factors of severe infections (p < 0.001). The use of antimalarials exerted a protective effect from severe infection [OR = 0.19 (95% CI 0.03-0.9)] p < 0.03.
Asunto(s)
Lupus Eritematoso Sistémico , Humanos , Adulto Joven , Adulto , Persona de Mediana Edad , Lupus Eritematoso Sistémico/epidemiología , Estudios Retrospectivos , Prevalencia , Túnez , Factores de Riesgo , CorticoesteroidesRESUMEN
PURPOSE: To compare efficiency and tolerance between topical 0.5% cyclosporine A (CSA) and fluorometholone (FML) for subepithelial infiltrates (SEI) complicating epidemic keratoconjunctivitis. METHODS: We conducted a prospective double-blind randomized study involving 72 eyes with SEI. Thirty-eight eyes were treated with topical FML (FML group) and 34 eyes with CSA 0.5% eye drops (CSA group). Treatment was considered successful in case of SEI reduction and visual acuity improvement. Tolerance was evaluated by Schirmer test value, burning on eye drops instillation, and conjunctival injection. RESULTS: Baseline characteristics of both groups were similar (P > 0.05). After 3 months of the regimen, resolution of SEI was 3 times more observed in the FML group than that in the CSA group (P = 0.026). After 6 months, resolution of SEI was observed in 70% of the FML group and in 47% of the CSA group (P = 0.068). The recurrence of SEI was almost twice higher in the FML group than that in the CSA group (16% vs. 9%). FML was better tolerated during the first 3 months: a higher Schirmer test value (P = 0.0003), less burning on instillation (P = 0.242), and less conjunctival injection (P = 0.003). For the rest of the follow-up period, the 2 groups were comparable in tolerance. No ocular hypertension was noted. CONCLUSIONS: Epidemic keratoconjunctivitis can evolve favorably under both FML and CSA. The effect of FML is faster and CSA is more durable with fewer recurrences. Both are safe therapeutic options for long-term control of SEI.
Asunto(s)
Infecciones por Adenovirus Humanos/tratamiento farmacológico , Conjuntivitis Viral/tratamiento farmacológico , Ciclosporina/uso terapéutico , Epitelio Corneal/efectos de los fármacos , Fluorometolona/uso terapéutico , Glucocorticoides/uso terapéutico , Inmunosupresores/uso terapéutico , Infecciones por Adenovirus Humanos/patología , Infecciones por Adenovirus Humanos/virología , Administración Oftálmica , Adolescente , Adulto , Anciano , Niño , Conjuntivitis Viral/patología , Conjuntivitis Viral/virología , Método Doble Ciego , Epitelio Corneal/patología , Epitelio Corneal/virología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Soluciones Oftálmicas , Estudios Prospectivos , Resultado del Tratamiento , Agudeza Visual/fisiologíaRESUMEN
PURPOSE: Systemic Lupus Erythematosus (SLE) in males is rare. Clinical and biological features, as well as, the outcome may differ comparatively to female patients. The purpose of our study is to define these clinical and biological features in Tunisian male patients presenting SLE. METHODS: A mono-centric, retrospective and descriptive study of 96 patients followed for SLE out of which 21 are males. A comparative study was then performed between male and female patients groups. RESULTS: Sex-ratio female/male was 3.6/1, the average age at diagnosis of SLE was 37.8±14 years. The most frequently noted clinical manifestations were: skin involvement (81%), renal involvement (71.4%) and joint damage (66.7). We observed a significant difference in clinical features between male and female patients (21 males and 76 females): renal failure (52% vs. 71.4%), serositis (23.8% vs. 2.7%), peripheral neuropathy (19% vs. 4%) and lung interstitial disease (14.3% vs. 1.3%). No significant difference was found in the positivity of serum antibodies between the two groups. Fifteen male patients (71.4%) had a SLEDAI score greater than or equal to 11, referring to high/very high disease activity. Out of the 32 patients who developed infectious complications during the course of the disease, 11 were male (52.4% of males). Concerning the male group, complete remission was observed in 10 patients (47.6%), while 10 others presented persistent sequella. We observed one death in the male group secondary to infective acute respiratory failure. CONCLUSION: SLE in male patients is rare and associated with poor prognosis. Disparity was observed in clinical and biological features as well as outcome in the different studies. In our study, we concluded that male lupus is more severe.
Asunto(s)
Antirreumáticos/uso terapéutico , Hidroxicloroquina/uso terapéutico , Lupus Eritematoso Sistémico/diagnóstico , Adulto , Femenino , Humanos , Lupus Eritematoso Sistémico/tratamiento farmacológico , Masculino , Persona de Mediana Edad , Pronóstico , Estudios Retrospectivos , Índice de Severidad de la Enfermedad , Factores Sexuales , Evaluación de Síntomas , Resultado del Tratamiento , TúnezRESUMEN
Cardiac manifestations develop in the majority of patients with systemic lupus erythematosus (SLE) at some time during the course of their disease. This study was designed to assess cardiac abnormalities in patients with SLE by echocardiography and to compare the 2 groups of patients with and without cardiac manifestations. It was a transversal, descriptive study, conducted in the Internal Medicine Department at the Military Hospital of Tunis from January 2016 to June 2018. Eighty lupus patients, diagnosed on the basis of ACR (American college of rheumatology) criteria, were enrolled in the study and were evaluated by standard echocardiography with color Doppler. Out of 80 patients 42 (52%) had abnormal echocardiographic findings. Pericardial effusion was found in 55%, valvular abnormalities in 52% and 38% had pulmonary hypertension. Patients with pleural effusion (45 vs 15%) were more vulnerable to cardiac involvement as well as renal impairment (57 vs 44%). The difference, however, were not statistically significant (p>0.05) in the renal involvement. Active disease with low complement (80%) was associated with higher frequency of cardiac involvement than disease in remission (64%) but the result was not statistically significant (p=0.11). Cardiac abnormalities are very common in lupus patients even when clinically asymptomatic form. Echocardiography is an excellent non-invasive tool for cardiac evaluation. Their research must be systematic with echocardiography in order to reduce subsequent cardiac morbidity and mortality among the lupus patients.
Asunto(s)
Ecocardiografía/métodos , Cardiopatías/diagnóstico por imagen , Lupus Eritematoso Sistémico/complicaciones , Adulto , Anciano , Anciano de 80 o más Años , Estudios Transversales , Femenino , Cardiopatías/epidemiología , Cardiopatías/etiología , Enfermedades de las Válvulas Cardíacas/diagnóstico por imagen , Enfermedades de las Válvulas Cardíacas/epidemiología , Enfermedades de las Válvulas Cardíacas/etiología , Hospitales Militares , Humanos , Hipertensión Pulmonar/diagnóstico por imagen , Hipertensión Pulmonar/epidemiología , Hipertensión Pulmonar/etiología , Masculino , Persona de Mediana Edad , Derrame Pericárdico/diagnóstico por imagen , Derrame Pericárdico/epidemiología , Derrame Pericárdico/etiología , Derrame Pleural/diagnóstico por imagen , Derrame Pleural/epidemiología , Derrame Pleural/etiología , TúnezRESUMEN
Human toxocariasis is a cosmopolitan parasitic zoonosis caused by Toxocara canis and Toxocara cati which are roundworms of dogs and cats. It is mostly a benign condition. We here report a case of acute pancreatitis secondary to toxocariasis.
Asunto(s)
Pancreatitis/etiología , Toxocariasis/complicaciones , Zoonosis/complicaciones , Enfermedad Aguda , Animales , Humanos , Masculino , Pancreatitis/parasitología , Adulto Joven , Zoonosis/parasitologíaRESUMEN
Tissue calcification is a common complication in patients on continuous hemodialysis (HD) for chronic renal failure; however, severe calcification is unusual. Three distinct clinical types of extraosseous calcifications are found in uremic patients: vascular calcification, periarticular (tumoral) calcification, and visceral calcification (heart, lung, and kidney). We report a case of a young chronic HD patient who presented with extensive metastatic calciï¬ cations both vascular, visceral specially localized in the lungs, and periarticular with progressively increasing multiple subcutaneous swellings. This evolution was secondary to noncompliance of the patient to the treatment of a malignant hyperparathyroidism with a marked elevation of phosphocalcium product.
Asunto(s)
Calcinosis , Diálisis Renal , Humanos , Hiperparatiroidismo Secundario , Fallo Renal CrónicoRESUMEN
Sarcoidosis is a multisystemic disorder of unknown etiology which is characterized by the formation of non-caseating granulomas in involved tissues. Cardiac involvement is one of the least common manifestations and it can occur at any point of time during the course of sarcoidosis. Here we present the case of 2 patients with known sarcoidosis who develop cardiac abnormalities in the absence of known primary cardiac cause. In our report, we would like to draw attention to the importance of considering heart involvement in any case with systemic sarcoidosis especially in young age.
Asunto(s)
Cardiopatías/etiología , Sarcoidosis/complicaciones , Adulto , Femenino , Cardiopatías/fisiopatología , Humanos , Persona de Mediana Edad , Pronóstico , Sarcoidosis/fisiopatologíaRESUMEN
Pyoderma gangrenosum (PG) and Sweet's Syndrome (SS) are inflammatory skin diseases caused by the accumulation of neutrophils in the skin and, rarely, in internal organs. These neutrophilic dermatosis (NDs) are distinguished by the existence of forms of transition or overlap. They are frequently associated to systemic diseases especially hematologic and gastrointestinal ones. We report a case of a patient with ulcerative colitis (UC) who successively developed two types of NDs: PG then SS. A 66 years old patient with a history of UC consulted in July 2012 for an erythematous swelling of the back of the right hand treated with antibiotics without improvement. At that time, bacteriological samples were negative. In October 2012, he was hospitalized for polyarthralgia and impaired general condition. In physical examination, he had vesiculobullous plaque of 10 cm long of the right hand and wrist, infiltrated erythematous plaque on the right leg and another topped with a large pustule at the left ankle. Skin biopsy showed at the back of the right hand an aspect of PG and at the infiltrated plaques of the ankle an aspect of SS. Prednisone was started with improvement of the skin lesions and a recovery condition. The combination of PG and SS has already been described in cases of hematologic malignancy and rarely in UC. There is also the notion of passage from a neutrophilic dermatosis to another. Indeed, a typical lesion initially of SS can evolve to a future PG. This case demonstrates that neutrophilic dermatoses form a continous spectrum of entities that may occur in UC.
Asunto(s)
Colitis Ulcerosa/complicaciones , Piodermia Gangrenosa/etiología , Síndrome de Sweet/etiología , Anciano , Biopsia , Colitis Ulcerosa/fisiopatología , Glucocorticoides/uso terapéutico , Humanos , Masculino , Prednisona/uso terapéutico , Piodermia Gangrenosa/diagnóstico , Piodermia Gangrenosa/patología , Síndrome de Sweet/diagnóstico , Síndrome de Sweet/patologíaRESUMEN
Renovascular hypertension (RVH) is among the most common forms of secondary hypertension. We studied 21 patients (eight male and 13 female) with RVH who were encountered during a period of 16 years. The average age of the patients was 34.75 years. Trans-renal Doppler ultrasound confirmed the diagnosis of renovascular stenosis (RAS) as the cause of RVH in 95% of the patients. Computed tomography angiography was performed in ten cases, which confirmed the diagnosis in all these cases. Magnetic resonance angiography was performed in only three patients. Renal scintigraphy was performed in 11 patients, with DTPA in nine patients and with MAG3 in two cases. Arteriography was performed in 15 cases for therapeutic end points. In two patients, we treated the arteries of both kidneys and in 19 cases we treated only one kidney artery. Percutaneous transluminal angioplasty was performed in ten cases. Renal arterial stent placement was performed in three cases in which RAS was from an atherosclerosis etiology. Surgical revascularization was performed in four cases. Nephrectomy was necessary in four cases. After interventional treatment, medical treatment using antihypertensive drugs was necessary in 17 of the patients. After treatment, three patients returned to normal kidney function, while worsening of glomerular filtration rate was noted in four patients. Some complications such as a kidney infarct after treatment, a nephrectomy, artery thrombosis, an ischemic stroke and recurrent RAS were also noted.
Asunto(s)
Hipertensión Renovascular , Obstrucción de la Arteria Renal , Adolescente , Adulto , Anciano , Angioplastia de Balón/instrumentación , Antihipertensivos/uso terapéutico , Presión Sanguínea , Femenino , Tasa de Filtración Glomerular , Humanos , Hipertensión Renovascular/diagnóstico , Hipertensión Renovascular/etiología , Hipertensión Renovascular/fisiopatología , Hipertensión Renovascular/terapia , Angiografía por Resonancia Magnética , Masculino , Persona de Mediana Edad , Nefrectomía , Renografía por Radioisótopo , Obstrucción de la Arteria Renal/complicaciones , Obstrucción de la Arteria Renal/diagnóstico , Obstrucción de la Arteria Renal/fisiopatología , Obstrucción de la Arteria Renal/terapia , Estudios Retrospectivos , Stents , Factores de Tiempo , Tomografía Computarizada por Rayos X , Resultado del Tratamiento , Ultrasonografía Doppler , Adulto JovenAsunto(s)
Proteína Antagonista del Receptor de Interleucina 1/uso terapéutico , Miocarditis/tratamiento farmacológico , Enfermedad de Still del Adulto/complicaciones , Humanos , Inmunoglobulinas Intravenosas/uso terapéutico , Masculino , Miocarditis/complicaciones , Enfermedad de Still del Adulto/diagnóstico , Enfermedad de Still del Adulto/tratamiento farmacológico , Adulto JovenRESUMEN
A 68-year-old female presented with inflammatory lumbalgia and cruralgia. Physical examination revealed a lumbar stiffness without neurological deficit. Secondarily, paraplegia and urinary retention appeared. Magnetic resonance imaging showed a vertebral compaction of L3 vertebra with medullar compression. Emergent surgery revealed an epidural tumor involving largely the L3 vertebral body. Histology found schwannoma with positive protein S100 on the immunohistochemical study. Metastasis screening revealed bilateral nodular lesions of the lungs and a trochanter high scintigraphic signal. It was a malignant schwannoma. The patient underwent radiotherapy in addition to the total tumor resection.
RESUMEN
Introduction. Malaria had been eliminated in Tunisia since 1979, but there are currently 40 to 50 imported cases annually. Soldiers are no exception as the incidence of imported malaria is increasing in Tunisian military personnel after returning from malaria-endemic area, often in Sub-Saharan Africa. Methods. We retrospectively analyzed the clinical and biological presentations, treatment, and outcomes of 37 Tunisian military personnel hospitalized at the Department of Internal Medicine, the Military Hospital of Tunis, between January 1993 and January 2011, for imported malaria. The clinical and laboratory features were obtained from the medical records and a questionnaire was filled by the patients about the compliance of malaria prophylaxis. Results. Thirty-seven male patients, with a mean age of 41 years, were treated for malaria infection. Twenty-two were due to Plasmodium falciparum. The outcome was favourable for all patients, despite two severe access. The long-term use of chemoprophylaxis has been adopted by only 21 (51%) of expatriate military for daily stresses. Moreover, poor adherence was found in 32 patients. Conclusion. The risk of acquiring malaria infection in Tunisian military personnel can largely be prevented by the regular use of chemoprophylactic drugs combined with protective measures against mosquito bites.