Associated arterial and venous cerebral manifestations in Behçet's disease.

Behçet's disease is a rare multisystemic vasculitis with an etiology that is still unknown. Neurological manifestations may be seen in approximately 5-15% of patients, and both parenchymal and extraparenchymal neurological involvement has been described. When cerebral venous thrombosis (CVT) is the main extraparenchymal manifestation of Behçet's disease, the condition is then dubbed "angio-Behçet's syndrome". However, arterial involvement is extremely rare, with only one reported case of vasculo-neuro-Behçet's disease, characterized by both venous and intracranial arterial involvement - until now. This report is of two patients diagnosed with Behçet's disease characterized by the concomitant presence of both cerebral arterial manifestations and CVT.

Impact of microbiological samples in the hospital management of community-acquired, nursing home-acquired and hospital-acquired pneumonia in older patients.

We investigated the positivity rate, the detection rates for non-covered pathogens and the therapeutic impact of microbiological samples (MS) in community-acquired pneumonia (CAP), nursing home-acquired pneumonia (NHAP) and hospital-acquired pneumonia (HAP) in elderly hospitalised patients. Patients aged 75 years and over with pneumonia and hospitalised between 1/1/2013 and 30/6/2013 in the departments of medicine (5) and intensive care (1) of our university hospital were included. Microbiological findings, intra-hospital mortality and one-year mortality were recorded. Among the 217 patients included, there were 138 CAP, 56 NHAP and 23 HAP. MS were performed in 89.9, 91.1 and 95.6 % of CAP, NHAP and HAP, respectively. Microbiological diagnosis was made for 29, 11.8 and 27.3 % of patients for CAP, NHAP and HAP, respectively (p = 0.05). Non-covered pathogens were detected for 8 % of CAP, 2 % of NHAP and 13.6 % of HAP (p = 0.1). The antimicrobial spectrum was significantly more frequently reduced when the MS were positive (46.7 % vs. 10.8 % when MS were negative, p = 10(-7)). The MS positivity rate was significantly lower in NHAP than in CAP and HAP. MS revealed non-covered pathogens in only 2 % of NHAP. These results show the poor efficiency and weak clinical impact of MS in the management of pneumonia in hospitalised older patients and suggest that their use should be rationalised.

[Colchicine and non-severe ocular inflammation excluding Behcet's disease: 16 cases and literature review]. / Colchicine et inflammation oculaire non sévère hors maladie de Behcet : 16 cas et revue de la littérature.

INTRODUCTION: Colchicine is a narrow therapeutic margin drug that does not have the adverse effects of corticosteroids and immunosuppressants. Its use in non-severe ocular inflammatory disease excluding Behcet's disease has not been studied. METHODS: We included patients seen in the internal medicine department of Dijon University Hospital consecutively between September 2020 and September 2021 if they had received colchicine during their pathology. Patients with suspected Behçet's disease were excluded. Treatment efficacy was studied in patients with at least one year of disease progression who had received more than one year of colchicine. Successful treatment was defined as a 50 % reduction in the number of annual relapses on colchicine. RESULTS: Sixteen patients were included (9 women and 7 men). They had recurrent anterior uveitis (n=10), recurrent scleritis (n=5) and intermediate uveitis. Opthalmological involvement was neither severe nor complicated. All patients combined, the annual relapse ratio (ARR) decreased from 1.8 (0.8-3.5) to 0.3 (0-1.6), (P=0.06). Colchicine was considered effective in three of 10 analyzable patients. In only one patient, treatment was stopped for adverse effects after six weeks. CONCLUSION: In view of the interesting benefit-risk ratio of colchicine, it seems appropriate to focus on this molecule in non-granulomatous anterior uveitis and non-severe recurrent scleritis.

[Crohn's disease during the course of multiple sclerosis: role of interferon-beta therapy]. / Maladie de Crohn au cours d'une sclérose en plaques: rôle de l'interféron bêta.

Interferon-beta (IFN-beta) therapy can trigger immune adverse effects. We report a patient, who was treated for multiple sclerosis (MS) by IFN-beta during 3 years before developing a severe colitis due to Crohn's disease (CD). Neurological manifestations may occur in CD but rarely mimic MS. This report's points highlight the possible association of MS and CD, where IFN-beta therapy probably unmasked CD. Indeed, similar cases of CD flares have been reported after IFN-alpha therapy for chronic C hepatitis.

[Excessive sweating related to hydromorphone]. / Sueurs profuses invalidantes sous hydromorphone.

Diffuse and abundant sweating in a middle age patient evolving for several weeks should raise suspicion of malignant lymphoma and infectious or neuroendocrine disorders before considering a drug origin. We report a patient who presented with severe and invalidating excessive sweating related to hydromorphone therapy for vertebral pain. Amongst their many reported side-effects, excessive sweating disappearing with discontinuation of the drug have been reported with some opiates.

[Use of biotherapy in the management of Behçet's disease in a department of internal medicine]. / Recours à la biothérapie dans la prise en charge de la maladie de Behçet dans un service de médecine interne.

BACKGROUND: Behçet's disease (BD) is a recurrent multisystemic disease responsible for occlusive vasculitis with arterial, venous and capillary involvement. The aim of this study was to determine the frequency and the features associated with the use of biotherapy in the management of patients followed in our department for BD. METHODS: This is a retrospective study of patients medical records followed for BD in a department of internal medicine from January 2005 to August 2018. RESULTS: A total of 41 patients were included with a mean age at diagnosis of 42.5±12.1 years (range 16 to 63) and a sex ratio men/women of 1.05. Oral and/or genital aphtosis was present in 70.7% of the patients. Other lesions were: ocular (78.0%), articular (46.3%), cutaneous (41.5%), central neurological (34.1%), vascular (26.8%), digestive (7.3%), pericardial (2.4%) and epididymal (2.4%). A biotherapy, interferon α and monoclonal antibodies, was used in 15 patients (36.6%), after failure of conventional treatments. The monoclonal antibodies were anti-TNFα (infliximab, adalimumab, certolizumab and golimumab) except in one patient for whom ustekinumab was used. Biotherapy was used in 46.9% of the patients with ocular involvement and never used in those patients without ocular involvement (P=0.01). CONCLUSION: Biotherapy is effective and represents a solution to the failures of conventional treatments in severe forms of Behçet's disease with ocular involvement.

[Stroke in young adults with celiac disease]. / Accident vasculaire cérébral ischémique de l'adulte jeune au cours de la maladie coeliaque. A propos de deux observations.

INTRODUCTION: Celiac disease is a common condition with a prevalence of about 1%. Clinical extradigestive presentations are various and stroke can be one of the neurological manifestations. EXEGESIS: Two cases of stroke occurring in young adults are described, leading to the diagnosis of celiac disease. Hyperhomocysteinemia or cerebral arterial vasculopathy in one case and antiphospholipid syndrome in the other case are thought to be involved in the pathogenesis of stroke during celiac disease. CONCLUSION: The possible presence of celiac disease should be discussed in unexplained young adult stroke.

[Quality of life measures in SLE: An update]. / Mesures de qualité de vie au cours du lupus systémique : état des lieux, actualité et utilisation pratique.

Systemic lupus erythematosus (SLE) is a chronic disease that considerably hampers patient's daily living. Qualitative studies with patients' interviews have been conducted to describe the experiences and perspectives of adults living with SLE. Among existing generic and disease-specific quality of life (QOL) questionnaires, none succeeded to exhaustively measure patient's preoccupations. However, these tools are useful to quantify the burden of the disease. Social precariousness, socioeconomic status and education level are intimately correlated to QOL measures, either generic or disease-specific. Musculoskeletal disease activity is also associated with a lower QOL. Using disease-specific tools may be useful because of a better aptitude to record an improvement in health status. Moreover, using generic and disease-specific questionnaires together may help to identify factors associated with a lower quality of life but not related to SLE from the patient's perspective (such as smoking or obesity). Developing new ways of recording QOL data in the future may help to evaluate the real benefit of using QOL scales in daily practice.

[Hyper-IgE in internal medicine]. / Hyper-IgE en médecine interne.

Hyper-IgE may be found under many pathological conditions. The role of IgE is essentially associated with the occurrence of allergic manifestations, which may be accompanied by an increase of their serum levels. Elevation of total IgE has also been reported in association with certain rare genetic immune deficiencies called hyper-IgE syndromes. Other circumstances such as infectious diseases, tumors or autoimmune diseases may also be accompanied by an excessive synthesis of IgE. Considering the diversity of these situations, discussion of the prognostic value of total IgE is useful to the internist.

[Interest of cotrimoxazole in relapsing idiopathic anterior scleritis: about six cases]. / Intérêt du cotrimoxazole dans les sclérites antérieures idiopathiques récidivantes: à propos de six observations.

INTRODUCTION: Anterior scleritis is defined as an inflammation of the sclera, located anteriorly to the equator of the eye. Cotrimoxazole is an antibiotic with an immunomodulatory action. EXEGESIS: In case of idiopathic anterior scleritis or scleritis associated with autoimmune diseases, immunosuppressive treatment is often required. We report on six patients with anterior idiopathic scleritis non sensitive to local treatment where cotrimoxazole improved or cured the symptoms. CONCLUSION: Cotrimoxazole seems to be an interesting therapeutic treatment in non threatening anterior scleritis.

[Heart and freezer: about one case of hypereosinophilia and coronary spasm]. / Coeur et congélateur: a propos d'un cas d'hyperéosinophilie et de spasme coronaire.

We report the case of a 41-year-old woman, non-smoker, without cardiovascular risk, hospitalised for acute ST elevation myocardial infarction. The coronarography showed no significant coronary stenosis and a methylergometrine test performed was positive. After the discovery of a moderate chronic hypereosinophilia, a review of the literature about eosinophile and coronary pathology was realised in order to make a link between hypereosinophilia and coronary spasm.

[Eye and cat scratch disease: A case series]. / Œil et maladie des griffes du chat : à propos de 7 cas.

INTRODUCTION: Cat scratch disease is a pleiomorphic condition, sometimes with isolated ophthalmic involvement. We report the clinical observations of seven cases with ophthalmologic manifestations of cat scratch disease. OBSERVATIONS: There were seven patients, with a median age of 52 years, of whom five were women and three had unilateral involvement. Six exhibited Leber's stellate neuroretinitis, an incomplete syndrome in two cases, and one associated with chorioretinal foci. One patient had isolated retinal infiltrates. The diagnosis of cat scratch disease was confirmed by Bartonella henselae serology, positive in all cases. All patients received treatment with doxycycline. Ocular complications (with optic atrophy and macular retinal pigment epithelial changes) were noted in five cases. DISCUSSION: Ocular bartonellosis is an atypical clinical form. It requires a directed ancillary work-up with serology or PCR, which has the peculiarity of being highly specific if not very sensitive. Treatment is above all preventive. Antibiotics may be initiated. CONCLUSION: Cat scratch disease must be excluded in the work-up of posterior uveitis.

[Treatment of cancer and hematological malignancy in elderly people: oncogeriatrics as a discipline for the future (Part I): geriatric evaluation and management of solid tumors]. / Prise en charge des cancers solides et des hémopathies malignes du sujet âgé : l'oncogériatrie une discipline en devenir Première partie: l'évaluation gériatrique et la prise en charge des cancers solides.

PURPOSE: Fifty percent of cancer arise in people older than 65 year-old. Most clinical trials in cancer treatment are limited in patients younger than 65 year-old. We review literature describing particularity of cancer treatment in elderly patients. CURRENT KNOWLEDGE AND KEY POINTS: Therapeutic decisions should be based on an estimation of the patient's life expectancy, and risks and benefits should be weighted up accordingly. Geriatric oncology is made of a geriatric evaluation of patient and of knowledge of clinical trial about elderly patients. FUTURE PROSPECTS AND PROJECTS: We present in this issue the principle of geriatric evaluation and the results of recent clinical trial on elderly cancer patients.

[Treatment of cancer and hematological malignancy in elderly people (Part II)]. / Prise en charge des cancers solides et des hémopathies malignes du sujet âgé: l'oncogériatrie, une discipline en devenir. Seconde partie: traitement des cancers solides (partie 2) et des hémopathies malignes du sujet âgé.

PURPOSE: Fifty percents of cancer arise in people older than 65-year-old. Most clinical trials in cancer treatment are limited in patients younger than 65-year-old. We review literature-describing particularity of cancer treatment in elderly patients. CURRENT KNOWLEDGE AND KEY POINTS: Therapeutic decisions should be based on an estimation of the patient's life expectancy, and risks and benefits should be weighted up accordingly. Geriatric oncology is made of a geriatric evaluation of patient and of knowledge of clinical trial about elderly patients. FUTURE PROSPECTS AND PROJECTS: We present in this issue the principle of geriatric evaluation and the results of recent clinical trial on elderly cancer patients.

Bilateral loss of vision and macular ischemia related to Behçet disease.

PURPOSE: To report a 61-year-old man with sudden onset of visual loss in both eyes related to bilateral macular ischemia. METHODS: The patient underwent comprehensive ophthalmic examination including slit-lamp and fundus examination, fluorescein angiography, and visual field testing as well as biologic screening. RESULTS: Bilateral macular ischemia associated with peripheral retinal vasculitis was confirmed by angiography. We diagnosed Behçet disease by association of ocular, oral, and cutaneous involvement according to the criteria of the international study group for Behçet disease. The patient was treated with corticosteroids. CONCLUSION: In Behçet disease, sudden onset of bilateral vision loss may be associated with bilateral retinal vascular disease and macular ischemia. Prompt diagnosis and treatment with systemic corticosteroids may be beneficial.

[Current aspects of paraneoplastic acute polyarthritis]. / Aspects actuels de la polyarthrite aiguë paranéoplasique.

Paraneoplastic acute polyarthritis (PAP) is a recognized rheumatological entity with semeiological features that are based only on a few published cases. We thought that it would be of interest to review the literature and present the current characteristics of PAP, taking into account only those cases where the acute polyarthritis and a neoplastic disease followed parallel courses. The clinical manifestations of PAP are extremely varied, making it difficult to distinguish this disease from some forms of rheumatoid arthritis, the RS3 PE syndrome or polymyalgia rheumatica. Clinicians must be vigilant when they are faced with a particularly progressive acute polyarthritis in a patient aged over 60, and particularly when this patient's general condition is altered and when fever and a clear-cut inflammatory syndrome are present. In such circumstances, it is mandatory to investigate for an underlying neoplasia.

[Yersinia bacteremia and iron overload]. / Bactériémie à Yersinia et surcharge en fer.

A retrospective multicentric study was conducted to determine the real prevalence of underlying iron overloads during Yersinia bacteremias. Ninety-seven cases of bacteremias (84 Yersinia enterocolitica, 13 Yersinia pseudotuberculosis) were registered between 1990 and 1996 in eastern France. Available data were collected in 70 cases (72.2%). Laboratory investigations of iron status were done in 53% (37/70). Three patients had a past record of known hemochromatosis, meanwhile in nine other cases an iron overload was discovered during the Yersinia bacteremia. Two cases of hemochromatosis were confirmed by liver histology. In all of these 12 cases, Yersinia enterocolitica was the causal agent. The effective prevalence of underlying iron overload in Yersinia bacteremias is 40% when researched, greater than data commonly published (1.8-14%), showing both epidemiological and clinical under estimation of iron's importance in Yersinia infection pathogenesis. A Yersinia bacteremia must be considered as an indicator of possible iron overload. Yersinia infection must be suspected in febrile hemochromatosic patients. A multicentric study must be conducted to evaluate incidence and characteristics of bacteremias in hemochromatosic patients.

[Adult cutaneous periarteritis nodosa and dental infections. Role of streptococci]. / Périartérite noueuse cutanée de l'adulte et infections dentaires. Rôle des streptocoques.

INTRODUCTION: Periarteritis nodosa can be associated with streptococcal infections in children. We report two cases of adult cutaneous periarteritis nodosa that disappeared after the treatment of dental infection. EXEGESIS: A 23-year-old woman presented with necrotic ulceration on the legs for 6 months, with a histology of necrotizing vasculitis. Many sites of dental infections could be noted. Immunological data were negative and so were serologies of hepatitis. Corticosteroid therapy failed. The teeth removal with antibiotic therapy allowed the disappearance of cutaneous lesions in a month. A 26-year-old woman was hospitalized for growing thin, fever, diffuse arthralgia and myalgia and cutaneous nodules on the legs with necrotizing vasculitis on dermal vessels at histological analysis. The biology showed no pecularity. Radiography of the teeth showed many dental infection sites. The removal of six teeth with antibiotic therapy led to the disappearance of vasculitis in 6 weeks. CONCLUSION: The search for an infectious problem is important when vasculitis is diagnosed, in particular periarteritis nodosa. The treatment of dental infection could occasionally mean avoiding immunosuppressive therapy in certain cases.

[Monoclonal gammopathies of undetermined significance in the elderly: apropos of 80 cases]. / Les gammapathies monoclonales de signification indéterminée chez le sujet âgé: à propos de 80 cas.

The authors reviewed the medical records of 80 patients with monoclonal gammopathy of undetermined significance who were examined at the hospital of Dijon between July 1990 and December 1992. The study included 43 males and 37 females with a mean age of 81.0 +/- 5.5 years. Type of M-component was IgG in 65% of the cases, IgA in 19% and IgM in 13.5%. A biclonal gammopathy was found in 2.5% of the cases. The follow-up duration was 24.6 +/- 10.8 months (range: 1-42 months). The survival probability of patients with monoclonal gammopathy of undetermined significance was 66.6% at 36 months compared with 75.6% in a control population. Lymphoplasmacytic disease developed in four patients (5%). There is a dramatic increase in monoclonal gammopathy with increasing age and the risk of malignant transformation must be continued whatever the age of patients. Further studies are required to determine routine follow-up in the elderly patient with monoclonal gammopathy of undetermined significance until the long term utility and cost/benefit ratio of screening techniques are known.