RESUMEN
BACKGROUND AND PURPOSE: The spectrum of COVID-19, caused by severe acute respiratory syndrome coronavirus 2 infection (SARS-CoV-2), includes different neurologic manifestations of the central and peripheral nervous system. METHODS: From March through April 2020, in two university hospitals located in western Switzerland, we examined three patients with Guillain-Barré syndrome (GBS) following SARS-CoV-2. RESULTS: These cases were characterized by a primary demyelinating electrophysiological pattern (Acute inflammatory demyelinating polyneuropathy or AIDP) and a less severe disease course compared to recently published case series. Clinical improvement was observed in all patients at week five. One patient was discharged from hospital after full recovery with persistence of minor neurological signs (areflexia). Two of the three patients remained hospitalized: one was able to walk and the other could stand up with assistance. CONCLUSIONS: We report three cases of typical GBS (AIDP) occurring after SARS-CoV-2 infection and presenting with a favourable clinical course. Given the interval between COVID-19-related symptoms and neurological manifestations (mean of 15 days) we postulate a secondary immune-mediated mechanism rather than direct viral damage.
Asunto(s)
COVID-19/complicaciones , Síndrome de Guillain-Barré/etiología , Conducción Nerviosa/fisiología , Progresión de la Enfermedad , Femenino , Síndrome de Guillain-Barré/tratamiento farmacológico , Síndrome de Guillain-Barré/fisiopatología , Humanos , Inmunoglobulinas Intravenosas/uso terapéutico , Persona de Mediana Edad , Suiza , Resultado del TratamientoRESUMEN
Mycobacterium lentiflavum is a nontuberculous, slowly growing mycobacterium usually recognized as a contaminant. Here, we report a case of disseminated M. lentiflavum infection responsible for hemophagocytic lymphohistocytosis in a heart-transplanted man.
Asunto(s)
Trasplante de Corazón , Linfohistiocitosis Hemofagocítica/complicaciones , Linfohistiocitosis Hemofagocítica/diagnóstico , Infecciones por Mycobacterium no Tuberculosas/diagnóstico , Infecciones por Mycobacterium no Tuberculosas/microbiología , Micobacterias no Tuberculosas/aislamiento & purificación , Anciano , Humanos , Masculino , Micobacterias no Tuberculosas/clasificaciónRESUMEN
OBJECTIVE: Several studies have reported poor long-term neuropsychological performances in patients following severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, but none has yet considered the effect of administering multiple intercorrelated neuropsychological tests and assessed the frequency of cognitive deficits in a normative population. Our aim was therefore to assess the presence of cumulative neuropsychological deficits in an actual post-coronavirus disease of 2019 (COVID-19) comparison group versus one simulated using Monte-Carlo methods. METHOD: Validated neuropsychological Monte-Carlo simulation methods were applied to scores from a battery of neuropsychological tests (memory, executive, attentional, perceptual, logical reasoning, language, and ideomotor praxis) administered to 121 patients who had had mild, moderate, or severe COVID-19 (mean age: 56.70 years; 32% women), 222 ± 43 days post-infection. The cumulative percentages of the three severity subgroups were compared with the results of a false discovery rate-corrected probability analysis based on normative data. RESULTS: The cumulative percentages of deficits in memory and executive functions among the severe and moderate patients were significantly higher than those estimated for the normative population. Moderate patients also had significantly more deficits in perception and logical reasoning. In contrast, the mild group did not have significantly more cumulative deficits. CONCLUSIONS: Moderate and severe forms of COVID-19 cause greater long-term neuropsychological deficits than those that would be found in a normative population, reinforcing the hypothesis of long-term effects of SARS-CoV-2 on cognitive function, independent of the severity of the initial infection.
Asunto(s)
COVID-19 , Trastornos del Conocimiento , Humanos , Femenino , Persona de Mediana Edad , Masculino , Síndrome Post Agudo de COVID-19 , Pruebas Neuropsicológicas , COVID-19/complicaciones , SARS-CoV-2 , Trastornos del Conocimiento/etiologíaRESUMEN
BACKGROUND: A neurocognitive phenotype of post-COVID-19 infection has recently been described that is characterized by a lack of awareness of memory impairment (i.e., anosognosia), altered functional connectivity in the brain's default mode and limbic networks, and an elevated monocyte count. However, the relationship between these cognitive and brain functional connectivity alterations in the chronic phase with the level of cytokines during the acute phase has yet to be identified. AIM: Determine whether acute cytokine type and levels is associated with anosognosia and functional patterns of brain connectivity 6-9 months after infection. METHODS: We analyzed the predictive value of the concentration of acute cytokines (IL-1RA, IL-1ß, IL-6, IL-8, IFNγ, G-CSF, GM-CSF) (cytokine panel by multiplex immunoassay) in the plasma of 39 patients (mean age 59 yrs, 38-78) in relation to their anosognosia scores for memory deficits via stepwise linear regression. Then, associations between the different cytokines and brain functional connectivity patterns were analyzed by MRI and multivariate partial least squares correlations for the whole group. RESULTS: Stepwise regression modeling allowed us to show that acute TNFα levels predicted (R2 = 0.145; ß = -0.38; p = .017) and were associated (r = -0.587; p < .001) with scores of anosognosia for memory deficits observed 6-9 months post-infection. Finally, high TNFα levels were associated with hippocampal, temporal pole, accumbens nucleus, amygdala, and cerebellum connectivity. CONCLUSION: Increased plasma TNFα levels in the acute phase of COVID-19 predict the presence of long-term anosognosia scores and changes in limbic system functional connectivity.
Asunto(s)
Agnosia , COVID-19 , Disfunción Cognitiva , Humanos , Agnosia/psicología , Disfunción Cognitiva/etiología , Citocinas , Trastornos de la Memoria , Factor de Necrosis Tumoral alfaRESUMEN
The early pathophysiologic study showed increasing evidence that autoimmunity is implicated in the pathogenesis of neuromyotonia. Antibodies to voltage gated potassium channel were detected in the serum of patients who had peripheral nerves hyperexcitability and also Morvan's disease or limbic encephalitis. These discoveries offered new approaches to treatments. Recently, antibodies previously attributed to VGKC recognise 2 surface antigens LGI1 and CASPR2 into the VGKC complex. Finally, VGKC antibodies are directed to 2 proteins the first one is a key hippocampic protein containing pre and post synaptic proteins. The second one CASPR2 is an hippocampic and paranodal protein. There clinical significance is different: hyperexcitability, limbic encephalitis without thymoma for LGI1, hyperexcitability, Morvan limbic encephalitis and frequent thymoma for CASPR2. In conclusion, the term NMT--LE--VGKC should be changed to NMT--LE with LGII and CASPR2 antibodies and classified as auto immune synaptic disorders. Mutations in genes encoding both these proteins are found in hereditary epilepsy and other syndromes. Various potassium channelopathies are closely linked to Morvan's syndromes. A new classification of antibodies will be necessary.
Asunto(s)
Autoanticuerpos/análisis , Síndrome de Isaacs/inmunología , Encefalitis Límbica/inmunología , Canales de Potasio con Entrada de Voltaje/inmunología , Humanos , Péptidos y Proteínas de Señalización Intracelular , Síndrome de Isaacs/diagnóstico , Encefalitis Límbica/diagnóstico , Proteínas de la Membrana/inmunología , Proteínas del Tejido Nervioso/inmunología , Proteínas/inmunología , Siringomielia/diagnósticoRESUMEN
INTRODUCTION: An observation of limbic encephalitis associated with Hodgkin's disease is compared with rare cases of the literature. The clinical presentation was relapsing episodes of febrile cognitive disorders with confusion and meningitis, curable after treatment of Hodgkin's disease. Recent concepts on limbic encephalitis are discussed. CASE REPORT: A seventy-five-year-old patient was hospitalized because of relapsing feverish confusion episodes with meningitis. During the year before his admission he had experienced four spontaneously regressive episodes of feverish confusion. Exploration of these episodes disclosed a paraneoplastic limbic encephalitis due to an underlying Hodgkin's disease. The treatment of Hodgkin's disease led to perfect recovery of cognitive function, so that the patient could drive his car. CONCLUSION: Lymphoproliferative disease, such as Hodgkin's disease, is a possible diagnosis in patients with limbic encephalitis. A dysimmune process underlying Hodgkin's disease might be operating in this association.
Asunto(s)
Confusión/etiología , Confusión/psicología , Enfermedad de Hodgkin/complicaciones , Enfermedad de Hodgkin/psicología , Encefalitis Límbica/etiología , Encefalitis Límbica/psicología , Meningitis/etiología , Meningitis/psicología , Anciano , Autoanticuerpos/análisis , Autoanticuerpos/aislamiento & purificación , Electroencefalografía , Fiebre/etiología , Enfermedad de Hodgkin/terapia , Humanos , Masculino , Recuperación de la Función , Recurrencia , Tomografía Computarizada por Rayos XRESUMEN
Introduction: Schnitzler syndrome is an auto-inflammatory disease defined by chronic urticarial eruption and monoclonal gammopathy. 18F fluorodeoxyglucose positron emission tomography/computed tomography (PET/CT) is often performed, but its utility in Schnitzler syndrome has not been specifically investigated. The aim of this study was to determine whether PET/CT is informative in the diagnosis and follow-up of Schnitzler syndrome relative to other imaging techniques, including bone scans.Patients and methods: Patients of this study were selected from the French cohort established by Néel et al. All patients with a diagnosis of Schnitzler syndrome (according to Strasbourg's and Lipsker's criteria) who had at least one PET/CT were included. Data were collected from medical records. PET/CT scans were all reviewed by a nuclear physician blinded to the clinical and imaging data.Results: Ten patients underwent at least one PET/CT scan and all had at least one 99mTechnetium bone scan during their follow-up. The most frequent PET/CT abnormalities were diffuse bone-marrow and/or increased femoral fluorodeoxyglucose uptake, but they did not correlate with disease activity. Conversely, bone-scan abnormalities, including mainly increased radiotracer uptake in long bones, appeared to strongly correlate with Schnitzler syndrome activity.Discussion: PET/CT does not appear to be useful for the diagnosis and follow-up of Schnitzler syndrome. However, bone scans appear to be more sensitive for diagnosis and may correlate with clinical activity. Bone scans may be well positioned to distinguish Schnitzler syndrome relapse from other aetiologies of bone, joint, or muscle pain.Conclusion: Bone scans may be favoured over PET/CT in Schnitzler syndrome.
Asunto(s)
Huesos/diagnóstico por imagen , Dolor/diagnóstico por imagen , Tomografía Computarizada por Tomografía de Emisión de Positrones/métodos , Síndrome de Schnitzler/diagnóstico por imagen , Tomografía Computarizada por Rayos X/métodos , Anciano , Anciano de 80 o más Años , Huesos/inmunología , Huesos/patología , Estudios de Cohortes , Femenino , Fluorodesoxiglucosa F18/farmacocinética , Humanos , Inmunoglobulina G/sangre , Inmunoglobulina M/sangre , Masculino , Persona de Mediana Edad , Dolor/sangre , Dolor/inmunología , Dolor/patología , Radiofármacos/farmacocinética , Síndrome de Schnitzler/sangre , Síndrome de Schnitzler/inmunología , Síndrome de Schnitzler/patologíaRESUMEN
We report on a 79-year-old woman having hemophagocytosis and capillary hyperpermeability syndrome who presented with anuric prerenal acute renal failure. The patient eventually died of a hypovolemic shock. Post-mortem biopsies evidenced a highly aggressive B cell intravascular lymphoma without amyloidosis. Physicians should be aware of the risk of anuric prerenal acute renal failure in the course of lymphoma-associated hemophagocytic syndrome.
Asunto(s)
Lesión Renal Aguda/etiología , Linfohistiocitosis Hemofagocítica/complicaciones , Linfoma de Células B/complicaciones , Lesión Renal Aguda/terapia , Anciano , Resultado Fatal , Femenino , Humanos , Linfohistiocitosis Hemofagocítica/diagnósticoRESUMEN
Links between Takayasu's arteritis (TA) and tuberculosis are discussed in the literature. We report the case of a Caucasian woman who was first seen for a regressive fever, associated with a normal clinical and chest and abdominal CT-scan examination. A minor granulomatous hepatitis was documented. She had no symptoms for the following four years. A second episode of persisting fever led to the diagnosis of simultaneous occurrence of diffuse TA and severe disseminated tuberculosis. Both affections were treated and the patient was still in good health after three years of follow-up. Simultaneous occurrence of both diseases in our observation supports evidence for a relationship between those two granulomatous diseases.
Asunto(s)
Arteritis de Takayasu/complicaciones , Tuberculosis Miliar/complicaciones , Corticoesteroides/uso terapéutico , Antituberculosos/uso terapéutico , Quimioterapia Combinada , Femenino , Humanos , Persona de Mediana Edad , Mycobacterium tuberculosis/aislamiento & purificación , Inhibidores de Agregación Plaquetaria/uso terapéutico , Índice de Severidad de la Enfermedad , Arteritis de Takayasu/diagnóstico , Arteritis de Takayasu/tratamiento farmacológico , Resultado del Tratamiento , Tuberculosis Miliar/diagnóstico , Tuberculosis Miliar/tratamiento farmacológicoRESUMEN
Systemic sclerosis (scleroderma) is a rare auto immune disease. Its physiopathology, based on various mechanisms, involves a predisposing genetic background and some exogenous factors. Among them, the role of toxic products is highly suggested according to several case-control studies. The aim of this study is to review the literature concerning occupational exposure associated with scleroderma. This review is completed by the results of a self-reported questionnaire on occupational exposures sent to 82 scleroderma patients followed in Marseille. Scleroderma associated with silica exposure should be declared as occupational disease. Moreover, the role of other toxic agents such as solvents is highly suspected and scleroderma occurring in case of high exposure should also be declared. Our study performed in Marseilles showed a occupational exposure in 10% of cases (five patients having an occupational exposure that could be involved in the genesis of the disease). One had an occupational silica exposure and was declared as occupational silica disease. Other cases had various toxic exposures including solvents and two were declared as disease of occupational nature. Occupational exposure (labour and leisure) must be searched for when faced with a scleroderma patient for two reasons: the possible declaration of an occupational disease and a better knowledge on toxics involved in scleroderma.
Asunto(s)
Exposición Profesional , Esclerodermia Sistémica/inducido químicamente , Anciano , Femenino , Francia , Humanos , Hidrocarburos/toxicidad , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Esclerodermia Sistémica/epidemiología , Solventes/toxicidad , Encuestas y CuestionariosRESUMEN
OBJECTIVE: Familial Mediterranean Fever (FMF) and TNF-Receptor Associated Periodic Syndrome (TRAPS) are two inheritable inflammatory disorders. They share some clinical manifestations but their treatments are different. We present here the case of an overlap syndrome of FMF and TRAPS in a patient carrying a mutation in both the MEFV and TNFRSF1A genes. CASE REPORT: A 20-year-old woman of Mediterranean origin had suffered since childhood from attacks of fever and arthritis, with skin and ophthalmic manifestations. The initial diagnosis was FMF. The symptoms responded poorly to colchicine but regressed with steroids. Genetic analysis revealed a homozygous M694V mutation in MEFV and a heterozygous R92Q mutation in TNFRSF1A. We discuss the complexity of this combined FMF-TRAPS phenotype. CONCLUSION: This case shows that mutations in MEFV and TNFRSF1A can occur together in a single patient, a condition that may modify its response to treatment. It would be interesting to evaluate the role of the R92Q mutation in TNFRSF1A in patients of Mediterranean origin with FMF unresponsive to colchicine.
Asunto(s)
Colchicina/farmacología , Proteínas del Citoesqueleto/genética , Fiebre Mediterránea Familiar , Supresores de la Gota/farmacología , Polimorfismo de Nucleótido Simple/genética , Adulto , Fiebre Mediterránea Familiar/complicaciones , Fiebre Mediterránea Familiar/tratamiento farmacológico , Fiebre Mediterránea Familiar/genética , Femenino , Humanos , Mutación , Fenotipo , Pirina , Receptores Tipo I de Factores de Necrosis Tumoral/genética , Síndrome , Factor 2 Asociado a Receptor de TNF , Péptidos y Proteínas Asociados a Receptores de Factores de Necrosis Tumoral/genéticaRESUMEN
Among neuroeosinophilic syndromes, neuromuscular disorders are considered as a special group, including perimyosistis, polymyositis and fasciitis. These three disorders are considered as a continuum. They usually without a recognized cause, and are considered to be spontaneous or exercise-induced. We report the case of a 43 year-old woman who experienced angioedema followed by an histologically proven-fasciitis with eosinophilia after Ramipril (Triatec) use. Causal attribution to Ramipril was considered "plausible". To our knowledge this side effect has never been reported with this drug.
Asunto(s)
Inhibidores de la Enzima Convertidora de Angiotensina/efectos adversos , Eosinofilia/inducido químicamente , Fascitis/inducido químicamente , Ramipril/efectos adversos , Adulto , Angioedema/inducido químicamente , Inhibidores de la Enzima Convertidora de Angiotensina/uso terapéutico , Erupciones por Medicamentos/etiología , Femenino , Humanos , Hipertensión/tratamiento farmacológico , Hipertensión/etiología , Obesidad/complicaciones , Ramipril/uso terapéuticoRESUMEN
INTRODUCTION: Rituximab is a chimeric anti-CD20 monoclonal antibody generally well tolerated. However, a severe but rare rituximab-related immune-toxic syndrome, associating fever, chills and thrombocytopenia can occur shortly after the infusion. CASE REPORT: We report a case of severe acute rituximab-induced thrombocytopenia with favorable outcome in a patient with chronic lymphocytic leukemia and discuss the possible underlying mechanisms. CONCLUSION: Despite the potential initial severity of rituximab-induced thrombocytopenia in CLL, chemotherapy should not be discontinued; tolerance might increase as the hematologic disorder is controlled.
Asunto(s)
Antineoplásicos/efectos adversos , Leucemia Linfocítica Crónica de Células B/tratamiento farmacológico , Rituximab/efectos adversos , Trombocitopenia/inducido químicamente , Enfermedad Aguda , Anciano , Humanos , MasculinoAsunto(s)
Aorta/fisiopatología , Aortitis/diagnóstico , Aortitis/etiología , Elasticidad/fisiología , Enfermedad de Erdheim-Chester/complicaciones , Adulto , Aortitis/fisiopatología , Aortografía , Velocidad del Flujo Sanguíneo/fisiología , Enfermedad de Erdheim-Chester/diagnóstico por imagen , Enfermedad de Erdheim-Chester/fisiopatología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Tomografía Computarizada por Rayos XRESUMEN
In patients treated for breast carcinoma, unilateral lymphedema of the upper limb is usual. However, to the authors' knowledge, lower limb lymphedema has never been reported as a complication of breast carcinoma therapy. They report here the first case of a radiation-induced constrictive pericarditis revealed by severe lower limbs lymphedema. A 60-year-old woman was treated for left breast carcinoma with quadrantectomy, axillary lymphadenectomy, and combined radio chemotherapy (60 grays). Three and a half years later she suffered from a diffuse and increasing lower limbs lymphedema, which became huge and disabling. Radiation-induced constrictive pericarditis was evidenced by right cardiac cavities catheterization. A dramatic improvement was rapidly obtained after pericardectomy. Histopathologic analysis of the pericardium did not reveal neoplastic cells. Radiation-induced constrictive pericarditis is usually responsible for lower limbs edema, but lymphedema is exceptional. This case highlights the need to search for a constrictive pericarditis also in the case of lower limbs lymphedema, particularly in a patient treated with mediastinal radiotherapy or combined radio chemotherapy.
Asunto(s)
Neoplasias de la Mama/radioterapia , Carcinoma Ductal/radioterapia , Edema Cardíaco/etiología , Pierna , Linfedema/etiología , Pericarditis Constrictiva/complicaciones , Pericardio/efectos de la radiación , Traumatismos por Radiación/complicaciones , Protocolos de Quimioterapia Combinada Antineoplásica/efectos adversos , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Neoplasias de la Mama/tratamiento farmacológico , Neoplasias de la Mama/cirugía , Carcinoma Ductal/tratamiento farmacológico , Carcinoma Ductal/cirugía , Terapia Combinada , Edema Cardíaco/diagnóstico , Femenino , Humanos , Escisión del Ganglio Linfático , Metástasis Linfática , Linfedema/diagnóstico , Linfedema/cirugía , Mastectomía Segmentaria , Persona de Mediana Edad , Pericardiectomía , Pericarditis Constrictiva/diagnóstico , Pericarditis Constrictiva/cirugía , Complicaciones Posoperatorias/diagnóstico , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/cirugía , Traumatismos por Radiación/diagnóstico , Traumatismos por Radiación/cirugía , ReoperaciónRESUMEN
SUBJECT: Hypothermia (defined as a core temperature lower than 35 degrees C) may result from accidental causes (exposure to cold, drug intoxications), from endocrine disorders (hypothyroidism), or from central or peripheral neurological disease. Among the causes of spontaneous hypothermia, the place of spontaneous periodic hypothermia or Shapiro's syndrome, of which less than 50 cases in children or adults have been reported, remains unclear. METHODS: Case series of spontaneous hypothermia in adults, from a register of the French Society of Internal Medicine (SNFMI). RESULTS: The ten collected cases of spontaneous hypothermia are heterogeneous. In half of the cases, an often ill-labeled psychiatric illness and/or epilepsy and/or anti-psychotic medication were found contributive. Only 5 cases at best seem to conform to the pattern of spontaneous periodic hypothermia or Shapiro's syndrome (in which agenesis of corpus callosum is typically found). In such cases, the episodes of hypothermia start with profuse hyperhidrosis suggesting a paroxystic reset of the hypothalamic thermostat with a lower temperature set point. In none of the cases was found a significant encephalic lesion. None of the treatment trials with anti-epileptics or cyproheptadine were found useful. Spontaneous hypothermia, whether periodic or not, seems to have an unpredictable course, with long periods of remission, and a benign long-term outcome. CONCLUSIONS: Spontaneous hypothermia is a symptom of likely multifactorial etiology. Even in cases conforming to the definition of Shapiro's syndrome, central nervous system anomalies are not unequivocal. No specific treatment for spontaneous hypothermia, whether periodic or not, can be recommended in the current state of knowledge.
Asunto(s)
Hipotermia/fisiopatología , Adulto , Anciano , Femenino , Humanos , Hipotermia/etiología , Masculino , Persona de Mediana Edad , Sistema de Registros , SíndromeRESUMEN
INTRODUCTION: Stiff-person syndrome is rare neurological disease, associating trunk rigidity and painful muscular spasms. A clinical variant of stiff person syndrome is the progressive encephalomyelitis with rigidity and myoclonus (PERM), which includes neurological cognitive disturbances. CASE REPORT: We report a 73-year-old woman initially addressed for abdominal pain, anorexia and severe weight-loss, for whom diagnosis of PERM was made. CONCLUSION: Because of its various clinical presentations, sometimes without evidence for neurological disease, the diagnosis of PERM is delayed. The presence of antineuropile antibodies associated with muscular spasms at electromyogram are strong evidence for this diagnosis.
Asunto(s)
Encefalomielitis/diagnóstico , Rigidez Muscular/diagnóstico , Dolor Abdominal/etiología , Anciano , Encefalomielitis/complicaciones , Femenino , Humanos , Rigidez Muscular/complicacionesRESUMEN
Infections and/or immune-mediated reactions may occur after intravesical instillation of bacillus Calmette-Guérin for the treatment of bladder carcinoma. We report herein a cryoglobulinemia vasculitis occurring after intravesical BCG instillation for a superficial papillary transitional cell bladder carcinoma. The patient, an 80-year-old man, presented peripheral ischemia 10 days after the second course of intravesical BCG instillation. Biological evaluation revealed autoimmune thrombocytopenia, hypergammaglobulinemia, low C3 and C4 complement fraction levels related to mixed cryoglobulinemia and lupus anticoagulant. The patient was treated with heparin and prostacyclins with a good outcome. All of the immune anomalies spontaneously regressed within 3 months. To our knowledge, cryoglobulinemia has only been reported once in the literature and lupus anti-coagulant has never been reported as a complication of intravesical BCG instillation.
Asunto(s)
Adyuvantes Inmunológicos/efectos adversos , Vacuna BCG/efectos adversos , Crioglobulinemia/etiología , Vasculitis/etiología , Adenocarcinoma/tratamiento farmacológico , Adyuvantes Inmunológicos/administración & dosificación , Administración Intravesical , Anciano , Anciano de 80 o más Años , Vacuna BCG/administración & dosificación , Crioglobulinemia/inmunología , Humanos , Masculino , Neoplasias de la Vejiga Urinaria/tratamiento farmacológico , Vasculitis/inmunologíaRESUMEN
The visceral form of leishmaniasis caused by Leishmania infantum is frequently observed in Mediterranean countries, however otorhinolaryngeal involvement has only rarely been reported in the literature. We report here the case of a 23-year-old Cameroon man, resident in France since 1991, and presenting with recurrent epistaxis and an epiglottis tumoral lesion. The visceral form of leishmaniasis with hepatosplenomegaly and pancytopenia was diagnosed. Culture of the epiglottal lesion revealed L. infantum. Serological test for human immunodeficiency virus was negative and the patient was not on immunosuppressive drugs. Dramatic improvement was observed with antimony.