[Right ventricular failure as the presenting manifestation of a carcinoid syndrome]. / Atteinte cardiaque droite révélatrice d'un syndrome carcinoïde.

We report a 75-year-old woman with a severe and symptomatic valvular tricuspid dysfunction, revealing a carcinoid syndrome, confirmed by an octreotid scan and liver biopsy. Carcinoid heart disease is a common complication of carcinoid syndrome associated with poor prognosis. Despite new pharmacological treatment, valve replacement surgery is the only curative treatment. Early diagnosis and multidisciplinary management could improve prognosis and quality of life of these patients.

[Oedematous polyarthritis and myopericarditis as presenting features of periarteritis nodosa]. / Polyarthrite oedémateuse et myopéricardite révélatrices d'une périartérite noueuse.

Remitting symmetrical seronegative synovitis with pitting edema (RS3PE) syndrome is a rare type of seronegative polyarthritis occurring in the elderly. It can be associated to various diseases. We report a case of RS3PE syndrome associated with myopericarditis, leading to the diagnosis of polyarteritis nodosa in a 71-year-old patient admitted to the hospital for a febrile acute polyarthritis with pitting edema of the hands associated with a marked inflammatory syndrome. On second day of hospitalization, a sustained chest pain led to the diagnosis of myopericarditis. Muscular biopsy showed necrotizing vasculitis, characteristic of polyarteritis nodosa. The coexistence of RS3PE and myopericarditis has never been described in the literature. Its association with polyarteritis nodosa is also very rare and only one case has been previously reported.

[Lepromatous leprosy revealed by a swollen hands syndrome]. / Syndrome des mains boudinées révélant une lèpre lépromateuse.

Osteoarticular pathology in leprosy is common and described at all stages, but rarely as the most evident clinical manifestation. We report a case of borderline lepromatous leprosy with initial and disabling hands edema. The swollen hands syndrome is probably due to chronic Mycobacterium leprae tenosynovitis.

[Vertebral osteomyelitis due to Streptococcus agalactiae ST-17]. / Spondylodiscite à Streptococcus agalactiae ST-17.

Streptococcus agalactiae has been traditionally considered as associated with neonates and pregnant women. Invasive diseases due to Streptococcus agalactiae are increasing in non-pregnant adults, especially with medical underlying conditions such as diabetes mellitus or neoplasia. Among these invasive manifestations, vertebral osteomyelitis remain exceptional. We report the case of a 49 year old man, without any risk factor, suffering from a vertebral osteomyelitis due to Streptococcus agalactiae. Assessment of virulence factors showed that the strain belonged to the serotype III, sequence type ST-17. The patient recovered well after prolonged antibiotic therapy. Although exceptional and associated with a favourable outcome, this case highlights the potential implication of Group B Streptococcus in vertebral osteomyelitis and the way to manage it.

[Non-diseases: another field for the specialist of internal medicine]. / Les non-maladies: un autre domaine de linterniste.

PURPOSE: Non-diseases are a heterogeneous group of symptoms, preoccupations or phenomenon that are felt or interpreted as pathological and so justifiable of medical intervention. Most doctors easily recognize illnesses that require no medical act. However, as a result of a medical misinterpretation or wrong reasoning, physicians may diagnose a non-disease and prescribe a non adapted treatment. KEY POINTS: This non exhaustive literature review, gives examples of anatomical, clinical, investigational, iatrogenic, psychiatric and collective non-diseases. Health education of the population, initial and continuing education of general and specialist practitioners and continuous assessment of advertising by the pharmaceutical industry are probably useful to limit the provision of medical care of non-pathological problems, which excessively request the physicians. CONCLUSION: The specialist of internal medicine, because of a wide knowledge of the medical specialities, has to recognize and learn the frequent traps of non-diseases.

[Interest of careful blood film observation in haemolytic anaemia diagnosis]. / L'intérêt de l'examen attentif du frottis sanguin dans le diagnostic des anémies hémolytiques.

The discovery of anaemia raises the question of its aetiology. If many causes can easily be established, some remain without any accurate diagnosis. The mere issue is that their causes can be rare or mechanisms interlinked. A blood film examination by the biologist provides helpful elements to guide the diagnosis, it can be improved if it is orientated by the physician who prescribed it. Two cases of late discovery of haemolytic anaemia, in relation with red cell membrane disorders, are reported. They illustrate the interest of a good collaboration between the physician and the biologist that lead to diagnosis. The first case is about a band-3 protein defect, the second deals with an hereditary dehydrated stomatocytosis.

[Recurrence of thromboembolic disease after splenectomy for hereditary xerocytosis]. / Maladie thromboembolique récidivante après splénectomie pour stomatocytose héréditaire.

CASE REPORT: The diagnosis of hereditary xerocytosis is made in a 57 year old woman splenectomized 30 years ago for a chronic hemolytic anemia. In following, she developed many thrombophlebitis of lower limbs and portal vein. DISCUSSION: The methods of diagnosis of this rare hereditary stomatocytosis are recalled, and the mechanisms of thrombotic tendency after splenectomy are discussed. This case underlines the fact that splenectomy is banned in the treatment of hereditary stomatocytosis, and that the serious consequences of iron overload, which is very frequent in this disease, must be prevented.

[Diabetes insipidus revealing chronic myelomonocytic leukemia]. / Diabète insipide central inaugural d'une leucémie myélomonocytaire chronique.

INTRODUCTION: Central diabetes insipidus is most frequently reported to occur after a trauma from surgery or accident. However, between 30 and 50% of cases are considered idiopathic. It's a rare complication of myelodysplastic syndrome. CASE REPORT: A 61-year-old patient presented central diabetes insipidus revealing, 17 months before, chronic myelomonocytic leukemia. Cytogenetics studies revealed monosomy 7. Acute myeloid leukemia appears 3 months after training rapid patient's death. DISCUSSION: Blood examination is necessary before to conclude idiopathic central diabetes insipidus. The discovery of chronic myelomonocytic leukemia implicates a rapid managing before its possible acute myeloid leukemia transformation. Indeed, prognosis of central diabetes insipidus and acute myeloid leukemia associated, in presence of monosomy 7, is very poor.

[Multi-organ failures during septic shock from Escherichia coli urinary tract infection: catastrophic antiphospholipid syndrome?]. / Défaillance multiviscérale au cours d'un choc septique d'origine urinaire à Escherichia coli: syndrome catastrophique des anticorps antiphospholipides?

INTRODUCTION: Although the presence of antiphospholipid antibodies is not an uncommon fact during infection, their responsibility in serious manifestations can still be debated and questions the existence of an actual catastrophic antiphospholipid syndrome or multivisceral faintings, triggered by the infection only, since the presence of antiphospholipid antibodies is not pathogenous. CASE: A 68-year-old man presented during an Escherichia coli urinary tract infection a septic shock with renal and cardiac insufficiencies, hepatic cytolysis and cholestasis and disseminated intravascular coagulation. There was a significant titer of antiphospholipid antibodies IgG (50 UGPL/ml) with an antibêta2-glycoprotein-1 positivity. The patient quickly recovered with antibiotherapy and intravenous immunoglobulins. DISCUSSION: Diagnosing the pathogeny of multivisceral faintings is founded of the clinical manifestations published during the catastrophic antiphospholipid syndrome, the evolution and the persistence of post recovery antibodies and the comparison with the visceral bouts that the sepsis exclusively as revealed.

[Pulmonary eosinophilia in France: possible toxocariasis]. / Poumon éosinophile en métropole, ne pas oublier la toxocarose.

INTRODUCTION: In France, except in the overseas departments and territories, pulmonary eosinophilia rarely has a parasitic cause except among subjects who have traveled to tropic areas. CASE: A 19-year-old man was hospitalized for incidentally discovered hypereosinophilia. The thoracic CT scan showed several hyperdense nodules that suggested bilateral interstitial alveolar lesions. Diagnosis was finally based on serologic results positive for toxocariasis. A 14-day course of albendazole led to regression of the eosinophilia and of the radiographic images. DISCUSSION: The frequency of toxocariasis or visceral larva migrans syndrome is probably underestimated. In adults, the symptoms can be atypical and possibly serious. Albendazole, for 14 days, is the reference treatment.

[Pemphigoid and acquired hemophilia]. / Pemphigoïde et hémophilie acquise.

INTRODUCTION: The association of bullous pemphigoid and acquired haemophilia is reported. CASE-REPORT: A 74 year-old man developed a bullous pemphigoid after decreasing corticotherapy, ecchymosis and haematomas revealing a high level of acquired anti-VIII antibodies (110 Bethesda UB units; TCA 98 s). Immunosuppressive treatment (cyclosporine, prednisone, azathioprine and bolus of cyclophosphamide) did not stop the disease. Perfusion of recombinant factor VIIa, human immunoglobulins and prednisone-azathioprine association permitted clinical and biological remission. DISCUSSION: Acquired haemophilia is idiopathic half the time. It can appear in autoimmmune diseases. Mortality is high. Only 4 cases of association with bullous pemphigoid have been reported in the literature. At the haemorrhagic phase, porcine factor VIII or more recombinant activated factor VII with human immunoglobulins are necessary. Immunosuppressive treatment is used to decrease production of anti-factor VIII antibodies.

[Diagnostic and treatment of hypereosinophilia upon return from the tropics: 102 patients]. / Diagnostic et traitement des hypereosinophilies sanguines au retour des tropiques: a propos de 102 patients.

Management of blood eosinophilia in travelers returning from the tropics is controversial. In this prospective study, 102 asymptomatic tropical travelers underwent investigation and treatment for hypereosinophilia. In contrast with direct tests for parasitic infection which were positive in only 15% of cases, immunological tests were suggestive of helminthic infection is 77%. The most common diagnoses were toxocarosis (49%), strongyloidiasis (30%), and filariasis (19%). Anti-parasite treatment was undertaken based on laboratory findings (12 cases) or on presumptive diagnosis using two-agent therapy (ivermectin and praziquantel) in 13 cases or three-agent therapy (ivermectin, praziquantel, flubendazole) in 77 cases. As a result of treatment, eosinophil count returned to normal in 61% of cases and decreased in 30%. These findings suggest that presumptive treatment of blood eosinophilia can be undertaken in tropical travelers using three anti-parasitic drugs: ivermectin (1 x 0.4 mg/kg), flubendazole (2 x 100 mg per day for 3 days), and praziquantel (1 x 40 mg). As a precaution before using ivermectin, tests should be performed to detect loiasis which can lead to adverse reactions.

[An uncommon cause of persistent fever in France]. / Une fièvre au long cours inhabituelle en France.

Miliary tuberculosis is rare and requires rapid diagnosis. Outcome is fatal in 25% of the cases. Since radiography and laboratory tests contribute little to early diagnosis, clinical findings are primordial. Antituberculosis antibiotic therapy is frequently started before microbiological confirmation of the diagnosis.

[Acute pericarditis of unusual etiology]. / Une péricardite aiguë d'étiologie inhabituelle.

Extrapulmonary manifestations of Legionella pneumophilia infection are infrequent. Cardiac involvement can occur. We observed an unusual case which led to acute pericarditis and reviewed the literature on cardiac involvement, particularly pericarditis, in patients which legionellosis.

[Organizing pneumonia during treatment with mesalazine]. / Pneumopathie organisée apparue sous mésalazine.

INTRODUCTION: The distinction between extra-intestinal manifestations of ulcerative colitis (UC) and drug-induced pneumonia can often be difficult. CASE REPORT: We describe the case of a 72-year-old male who presented fever and sub-acute respiratory insufficiency, after 4 months of treatment with mesalazine for ulcerative colitis (UC). Initial tests found serum C-reactive protein, eosinophil count and total IgE to be elevated. Routine bacteriological, fungal and mycobacterial cultures were negative. Bronchoalveolar lavage fluid cellularity was normal with elevated lymphocyte, neutrophil, and eosinophil counts (35 % mononuclear cells, 23 % lymphocytes, 28 % neutrophils, 14 % eosinophils). The diagnosis of organizing pneumonia (OP) with eosinophilic pneumonia component was confirmed after examination of a lung biopsy specimen. Clinical improvement occurred after cessation of mesalazine and initiation of prednisolone (1mg/kg/day). Nine months later, a recurrence of gastrointestinal symptoms required a 5 months reintroduction of an amino salicylate by topical therapy (4- acide aminosalicylique [ASA enemas]). There was no resurgence of the pneumonia. DISCUSSION: Organizing pneumonia is a rare extra-intestinal manifestation of UC. There was no resurgence of OP after amino salicylate enemas rechallenge but mesalazine-induced pneumonia cannot be excluded.