[Severe thrombocytosis and leukocytosis associated with iron deficiency anaemia: a case-report]. / Thrombocytose et hyperleucocytose sévères au cours d'une anémie par carence martiale: à propos d'un cas.

Reactive thrombocytosis (secondary thrombocytosis) is frequent and typically moderate. We report a case of extreme thrombocytosis and leukocytosis secondary to an iron deficiency anemia. A 21-year-old woman is admitted in emergency department for acute headache. Biological assessment reveals a severe microcytic anaemia (5.4 g/dL) with thrombocytosis (2500 giga/L) and leukocytosis (35 giga/L) leading to multiple diagnosis hypotheses. Finally, biological evaluation concludes to a diagnosis of iron deficiency anaemia related to insufficient oral intake and menorrhagia. Reactive hyperleukocytosis and thrombocytosis rapidly resolved with iron supplementation. This case is a reminder that iron deficiency-related thrombocytosis can sometimes be severe. However, the associated reactive leukocytosis is quite exceptional.

[Impact of an evaluation of the professional practices on the relevance of proton pump inhibitors prescriptions pertinence at the hospital]. / Impact d'une évaluation des pratiques professionnelles sur la pertinence des prescriptions d'inhibiteurs de la pompe à protons à l'hôpital.

INTRODUCTION: Proton pump inhibitors (PPI) are widely prescribed for unrecognized indications, at high a dose and for a long duration, in spite of side effects and numerous drug interactions. In 2009, the HAS (French Health Authority) published recommendations of good prescription but the latter are poorly respected. In this context of over prescription and additional cost for the society, we performed a professional practice evaluation of on the model of the Deming wheel. The objective of this work was to optimize the relevance of the prescriptions of the IPP in two services of internal medicine and geriatrics through an evaluation of the professional practices. All PPI prescriptions introduced in outpatient visits or during hospitalization were analyzed. PATIENTS AND METHODS: Data collection was prospective, over two periods of 2 months and included 163 (first phase), then 139 patients (second phase). An assessment grid of PPI prescriptions was completed by physicians regarding the active substance, the dose, the duration and the indication of the prescription. The relevance of the prescription corresponded to PPI with a conformed indication and duration and to the prescriptions no recommended stopped. Following the first period of data collection, information was given to medical students and physicians on the relevance of their prescriptions with regard to the current recommendations and informative flyers were offered with the aim of improving the practices before the second period of evaluation (second phase). RESULTS: During the first phase, only 25% of the pre-hospital prescriptions and 33% of the hospital prescriptions respected the HAS recommendations. The main indication of the PPI was the prevention of peptic ulcers in a context of associated drug estimated at risk. An improvement of the global relevance of prescription was observed after awareness of the physicians: 26% relevance during the first phase and 60% in the second one (P<0.012). During the second phase, the part of PPI prescriptions introduced at hospital decreased from 33 to 17% and the discontinuation of the not corresponding prescriptions increased from 6 to 33%, with an additional information given to the general practitioner (P<0.001). However, during the second phase, 33% of the prescriptions introduced in hospitalization were always not corresponding and 61% of the not corresponding prescriptions begun in outpatient visits were always pursued on discharge, probably due to the lack of sufficient information to stop the prescription. CONCLUSION: Our study underlines the frequent disrespect of the indications in the prescription of PPI. Interestingly, a professional practices evaluation improved the relevance of the prescriptions with a more frequent withdrawal of the not corresponding exposure and a decrease in global not corresponding prescriptions. Our study suggests that it is crucial to regularly inform physicians on the good prescription of PPI. Patient information focused on the indications and the limited duration of PPI prescription, potentially severe side effects of chronic exposure and on the risk of drug interactions also remains necessary in order to facilitate the stop of the exposure and restrict self-medication.

[The ictal bradycardia syndrome: a case report and review of the literature]. / Le syndrome de bradycardie comitiale: cas clinique et revue de la littérature.

Epilepsy is a rare cause of sinus node dysfunction which should be recognised. The authors report the case of a 55 year old woman with refractory epilepsy who had sinus arrest during her epileptic fits. After excluding a possible interaction by long-term Carbamazepine treatment, the diagnosis of the Ictal bradycardia syndrome was made in view of the simultaneous occurrence of severe bradycardia and epileptic activity recorded on electro-encephalography. Sudden death being more common in epilepsy, effective treatment of conductive cardiac abnormalities is essential. The refractory nature of the epileptic fits led to the implantation of a permanent pacemaker in this case.

[Syndrome of inappropriate antidiuretic hormone secretion disclosing a sinonasal neuroendocrine carcinoma: case report]. / Syndrome de sécrétion inappropriée d'hormone antidiurétique révélateur d'un carcinome ORL à petites cellules.

We report a 74-year-old woman with histologically confirmed neuroendocrine carcinoma of the nasal cavity disclosing a syndrome of inappropriate antidiuretic hormone secretion (SIADH). Since SIADH is a paraneoplastic syndrome commonly associated with small cell lung cancer, an extra-pulmonary localisation of neuroendocrine carcinoma has to be investigated.

[Pericarditis: a giant cell arteritis manifestation]. / La péricardite: une manifestation de la maladie de Horton.

INTRODUCTION: Temporal arteritis is a vasculitis in which inflammatory manifestations mainly involve the external carotid artery area but not exclusively. Through a clinical observation and a review of the literature, we suggest that inflammatory pericarditis could represent a manifestation of temporal arteritis. EXEGESIS: A 75-year-old-woman was admitted for progressive physical deterioration which had been evolving for three months, associated with fever, frontotemporal cephalalgia and severe biological inflammatory syndrome. Chest X-ray reveals a cardiomegaly and suggests a pericarditis, which was rapidly confirmed by echocardiogram. Temporal artery biopsy concludes to the diagnosis of a giant cell arteritis. Steroids treatment is prescribed, leading to a rapid regression of the inflammatory state and the pericarditis without relapse after 6 months of follow-up. CONCLUSION: Only prospective studies on systematic echocardiography when faced with the diagnosis of giant cell arteritis, whatever clinical symptoms, will enable to appreciate the prevalence and prognosis value of this manifestation. Moreover, temporal artery analysis seems to be justified when faced with a sub-acute or chronic "idiopathic" inflammatory pericarditis occurring in the elderly patient. Physiopathogeny is unknown but some hypothesis can be proposed: inflammatory cytokines storm, immune complexes deposition, giant cell vasculitis of pericardial arteries or inflammatory interstitial lesion of the pericardium with or without granuloma.

[Is pure red cell aplasia a new extra digestive manifestation of celiac disease?]. / L'érythroblastopénie: nouvelle manifestation extradigestive de la maladie coeliaque?

INTRODUCTION: Celiac disease is an autoimmune enteropathy that appears on a predisposed genetic background. Its clinical presentation has been extended those last years by varied extradigestive manifestations. EXEGESIS: This is a case report of a twenty-year-old woman who presented simultaneously a celiac disease and pure red cell aplasia. The IgA and IgG antigliadin antibodies as well as antinuclear, anti-DNA, anti-SSA and anti-SSB antibodies were detected, without any clinical symptom supporting the diagnosis of systemic lupus erythematosus or Sjögren syndrome. Thoracic CT-scan reveals a thymus enlargement and biopsy concludes to thymus hyperplasia at histological examination. Pure red cell aplasia regressed after gluten-free diet, corticoid therapy and thymectomy. CONCLUSION: This observation, added to the three others paediatric cases previously published in the literature concern an uncommon association between pure red cell aplasia and celiac disease. However, they are not enough to conclude to a direct link between these two disorders. Pure red cell aplasia could represent un new dysimmune manifestation occurring in celiac disease, but this will need to be confirmed with others cases.

[Necrotic myocarditis in acute eosinophilic lymphoblastic leukaemia]. / Myocardite nécrosante révélant une leucémie aiguë lymphoblastique hyperéosinophilique.

INTRODUCTION: Hypereosinophilia can cause severe cardiac complications. The association between an acute lymphoblastic leukemia and hypereosinophilia was rare. We report a case of a 29-year-old man who presented a heart failure secondary to necrotic myocarditis related to an acute eosinophilic lymphoblastic leukaemia. EXEGESIS: The patient developed a heart failure and secondary a cardio-embolic stroke, due to a large mobile left ventricle thrombosis. His peripheral blood showed a total white count of 28,500 leucocytes/mm3 with 18,800 eosinophils/mm3. The myelogram cytology showed precursor B-cell acute lymphoblastic leukaemia with hypereosinophilia. CONCLUSION: The possibility of the rapid emergence of cardiac lesions in hypereosinophilic syndromes warrants very close physician vigilance. An Echocardiography and MRI performed at the early stage and in the follow-up allow to detect and to manage these cardiac disorders.

[Ileum inflammatory fibroid polyp revealed by intussusception. About one familial case]. / Polype fibro-inflammatoire de l'iléon révélé par une invagination. A propos d'un cas familial.

INTRODUCTION: Acute ileum intussusception is a frequent and mostly benign condition in childhood. Conversely, it is a rare condition during adulthood and generally associated with an underlying malignancy. We report a familial form of benign inflammatory fibroid polyps, revealed by an acute ileum intussusception. EXEGESIS: A 41-year-old man, whose mother had undergone three surgical procedures for acute ileum intussusception associated with inflammatory fibroid polyp, was admitted for a abdominal pain that started three month ago. The patient displayed alteration of the intestinal transit, weight loss and sub-occlusive syndrome. Upper and lower endoscopies, performed before admission, were normal. In the emergency room, the abdominal computed tomography-scan revealed an acute intussusception of the last loop of the small intestine, probably caused by a tumor and leading to an occlusive syndrome. Surgical resection and histological analysis concluded to an inflammatory fibroid polyp. Clinical outcome was excellent. CONCLUSION: Inflammatory fibroid polyp is always a benign tumor. It is usually isolated, expressing itself mainly in the form of an acute intussusception when located in the small bowel. The familial form presented here is exceptional and illustrates the possibility of an inherited transmission of this disease. However the pathogenesis of this type of polyp is still unclear.

Arthritis following combined vaccine against diphtheria, polyomyelitis, and tetanus toxoid.

We describe 2 cases of arthritis following immunization against diphtheria, poliomyelitis and tetanus toxoid. One patient developed monoarthritis of the knee after immunization, that regressed following synovectomy. Five years later, the arthritis recurred after a booster vaccine injection. One day after immunization, another patient developed arthritis of the ankle that persisted for 3 days. It is difficult to know whether there is a coincidental or a causal relation between immunization and arthritis. Although our cases suggest that immunization against diphtheria, poliomyelitis and tetanus toxoid may cause arthritis, additional cases must be reported before studies aimed at confirming this possibility are considered.

[Valproate-induced hyperammonemic encephalopathy]. / Encéphalopathie hyperammoniémique au valproate de sodium.

Valproate is a drug commonly prescribed in neurology and psychiatry. Hyperammonemic encephalopathy due to valproate is a severe complication. A 44-year-old man with a past medical history of partial symptomatic epilepsy and alcoholic cirrhosis was admitted for drowsiness. He was receiving valproate and gabapentin. A valproate-induced hyperammonemic encephalopathy was diagnosed on physical examination, generalized slow waves on electroencephalogram and hyperammonemia. Valproate withdrawal led to a progressive recovery of the consciousness, with a rapid normalisation of electroencephalogram and ammonium level. The pathogenesis of this encephalopathy is not clearly established. No correlation has been shown between the severity of encephalopathy, the plasma ammonium level, the valproate dose and its plasma concentration. Additional factors have been pointed out, such as carnitine deficiency or urea cycle enzyme defects. Furthermore, our case suggests an enhancing role of the liver disease in this encephalopathy.

[Acute bowel intussusception revealing celiac disease: a new case and literature review]. / Invagination intestinale aiguë révélant une maladie cœliaque : à propos d'un cas et revue de la littérature.

INTRODUCTION: Acute bowel intussusception is a rare manifestation in adult, which mainly involves the small intestine. Celiac disease is a frequent small bowel disease that is largely undiagnosed in adults. We report a patient in whom spontaneously regressive small bowel intussusception was the presenting manifestation of celiac disease. CASE REPORT: A 40-year-old man was admitted for a right-sided iliac abdominal pain related to a small bowel intussusception. Laparotomy ruled out a digestive tumor. Persistence of diffuse abdominal pain associated with progressive and unexplained weight loss for several months led to the diagnosis of celiac disease, which was confirmed by the presence of specific serum autoantibodies and histological duodenal villous atrophy. CONCLUSION: The association between small bowel intussusception and celiac disease does not seem to be fortuitous. Based on this report and the literature review, we suggest that celiac disease can favour small bowel intussusception, even in adulthood. Therefore, diagnosis of celiac disease must be discussed in the presence of unexplained intussusception.

[Recurrent pericarditis revealing a systemic sarcoidosis]. / Péricardite récidivante révélant une sarcoïdose systémique.

INTRODUCTION: Sarcoidosis is a systemic granulomatous disorder of unknown cause, mainly involving the lung and the mediastinum. Involvement of the pericardium and peritoneum is rare, but can be the first manifestation of the disease. CASE REPORT: A 55-year-old female patient was followed-up for a recurrent "idiopathic" pericarditis. Diagnostis was challenged when she secondarily presented with enlarged hilar and mediastinal lymph nodes associated with pulmonary "nodules". Imaging with (18)F-FDG positron emission tomography with computed tomography showed multiple hypermetabolic foci in the mediastinum and peritoneum, which suggested a malignant disorder. Finally, histopathological evaluation of the peritoneal nodules revealed a sarcoidosis. A corticosteroid therapy was initiated and disease course was favourable. CONCLUSION: This case report highlights the importance of a unique explanation for a patient presenting with recurrent pericarditis associated with a systemic disease. Although rare, sarcoidosis should be discussed and diagnostic procedures should be performed to obtain histological confirmation.