C-Reactive Protein, Ferritin, and Procalcitonin in 300 Moroccan Patients with COVID 19.

BACKGROUND: COVID-19 is a true global pandemic since March 2020, and it is responsible in the majority of patients mild symptoms; however, a small number of patients progress to the severe form with acute respiratory distress syndrome (ARDS) and some of them progress to the very severe form which can be fatal when it comes to multiorgan failure. Thus, it is important to identify as early as possible patients at high risk of progressing to severe forms requiring early and specialized management in order to reduce mortality. METHODS: Our five-month retrospective study (May 2020 - October 2020) included 300 SARS-CoV-2 patients confirmed by RT-PCR and hospitalized in the Infectious and Tropical Diseases Center (CMIT), and in the Intensive Care Unit of the Military Hospital of instructions Mohamed V of Rabat (Morocco). Our objective was to compare the levels of C-reactive protein (CRP), ferritin, and procalcitonin (PCT) according to the clinical state and prog-nosis of patients. RESULTS: In our series of results, very significantly elevated levels of C-reactive protein, ferritin, and procalcitonin were associated with severe and very severe forms of COVID-19 disease as well as a poor prognosis. CONCLUSIONS: In the absence of international recommendations, the validation of clinical-biological scores involving different biological parameters in COVID-19 patients would allow a standardization of practices, a correct prescription of biological analyses and a risk stratification allowing to palliate the lack of medical resources and thus to reduce mortality.

Pulmonary hypertension and von Recklinghausen's disease: association and therapeutic difficulties.

The neurofibromatosis type 1 (NF1) or Von Recklinghausen's disease is a genetic disorder. The café-au-lait spots and neurofibromas are the most common manifestations. Respiratory symptoms are rare in this disease, described as neurofibromas, infiltrative lesions, cysts, bubbles or emphysema. Pulmonary hypertension is rarely reported. It is due to the plexiform lesions in pulmonary arterioles or to parenchymal lung lesions reducing the vascular bed. We report a case of idiopathic precapillary pulmonary hypertension in a young patient with Von Recklinghausen's disease.

[Adult refractory Still disease with atypical articular manifestations: efficacity of interleukin-6 antagonists (tocilizumab)]. / Atteintes articulaires atypiques au cours d'une maladie de Still de l'adulte réfractaire : efficacité des antagonistes de l'interleukine-6 (tocilizumab).

INTRODUCTION: Tocilizumab is a humanized monoclonal antibody directed against interleukin-6 receptor and is beginning to be reported as effective in some cases of Still's disease refractory in adults (ASD). ASD is rare, heterogeneous, with unpredictable evolution. The distal destructive arthritis represents a possible complication. PATIENT: We report an unusual case of adult-onset Still's disease with severe distal interphalangeal destructive arthritis with refractory early and prolonged remission after the first tocilizumab infusion. CONCLUSION: Tocilizumab can be used in patients with refractory ASD after failure or intolerance of conventional treatments.

Phenotypic expression of ferroportin disease in a family with the N144H mutation.

Ferroportin is a putative transmembrane channel involved in the exit of iron out of the enterocytes, the macrophages and the hepatocytes. Mutations in the human gene coding ferroportin have been linked to an unusual form of iron overload, now referred to as "hemochromatosis type IV" or "ferroportin disease" characterized by a prevalent iron overload of macrophages and liver Küpffer cells. We report four patients from a same family with ferroportin disease associated with the N144H mutation. We show that in this family the mutation which is fully penetrant, may act through an increased iron export from macrophages as suggested by the unexpected absence of iron overload in the spleen and bone marrow detected by magnetic resonance imaging, that it co-segregates with a phenotype close to the classical form of HFE-associated hemochromatosis and was associated, in the oldest patient, with the development of hepatocellular carcinoma in a non cirrhotic liver. Our findings illustrate the existence of a genotype-phenotype relationship in "ferroportin disease", suggest that MRI may be useful in determining this phenotype and show that hepatocellular carcinoma may occur in these patients even without cirrhosis. This observation justifies careful follow-up of this subgroup of patients.

[Acquired ichthyosis revealing an Hodgkin's disease]. / Ichtyose acquise révélant une maladie de Hodgkin. Une nouvelle observation.

INTRODUCTION: Acquired ichthyosis is a rare condition that usually reveals malignant diseases. CASE REPORT: A 70-year-old man was admitted with weight loss, diffuse ichthyosis, lymphadenopathy of the inguinal lymph nodes and elevated inflammatory markers in peripheral blood. Histology of the lymph node revealed mixed-cellularity Hodgkin disease. The evolution was fatal in spite of the chemotherapy. DISCUSSION: Acquired ichthyosis is a cutaneous paraneoplastic syndrome, generally related to hematologic malignancies. A possible pathomecanism is the stimulation of epidermal growth secondary to the production of epidermal growth factor (EGF) by tumour cells. Acquired ichtyosis can rarely reveal systemic or infectious diseases. It can also be drug-induced or idiopathic.

[Primary gastric lymphoma: a retrospective series of 35 cases]. / Le lymphome gastrique primitif (etude rétrospective d'une série de 35 patients).

BACKGROUND: Primary gastric non Hodgkin's lymphoma (PGNHL) is the most common site of extranodal malignant lymphoma. It is a rare subtype of malignancy, for which no consensus exists about treatment. AIM: The purpose of This paper was to assess the managemnt of PGNHL. METHODS: Between January 1992 and December 2001, 35 patients were retrospectively evaluated. RESULTS: Of the 35 patients, with a mean age of 44 years old Signs and symptoms are unspecific. 20 (57.1%) were in stage IE/IIE1. 15 patients (42.8%) were in stage IIE2,IIIE,IVE. These patients were treated with primary surgery with or without chemotherapy (11; 31.4%); primary chemotherapy (CT) alone with surgery in one patient (21; 60%) and three patients with gastric MALT lymphoma were treated by Helicobacter pylori eradication. The 5 year survival rates of the 35 patients are 62, 86%. There was no significant difference in the 5 year survival rate between the patients with low grade lymphoma and the patients with large grade lymphoma (75% versus 60%, P = 0.467). The 5-year survival rates for stage I/IIE1 and IIE2/III/IV patients were 80%, 53.3% respectively (p < 0.144). Of the 11 primary surgical groups with or without chemotherapy, the 5 year survival rate is 90.9%. Of the 21 patients who received CT, alone or combined with surgery, the survival rate is 52.4%. There was significant difference between the two groups (P = 0.05). Of the 3 patients with low-grade mucosa-associated lymphoid tissue (MALT) lymphoma with only oral anti-Helicobacter pylori regimen remained disease-free after a median follow-up of two years. CONCLUSIONS: This study suggested that primary surgical resection may be important factor predicting the long-term survival of patients with primary gastric NHL. H. pylori eradication therapy was an effective first-line treatment for patients with gastric MALT lymphoma.

[Hodgkin's disease presenting with spinal cord compression]. / Epidurite révélatrice d'une maladie de Hodgkin.

INTRODUCTION: Hematological neoplasms may be complicated by signs of neurological compression. Most cases reported in the literature have described advanced-stage non-Hodgkin lymphomas. We report a case of spinal cord compression revealing an isolated vertebral localization of Hodgkin lymphoma. CASE REPORT: Magnetic resonance imaging of the thoracic spine in a 54-year-old man who presented with spastic paraplegia revealed a vertebral and extradural mass. After laminectomy, histology and immunohistochemistry showed Hodgkin's disease. Post-operative staging did not reveal any other localization. The patient responded favorably after decompressive surgery and ABVD regimen. CONCLUSION: Spinal cord compression is a rare complication of Hodgkin's disease, occurring in only 5p.cent of cases, usually in the setting of progressive, advanced disease. As the initial symptom of Hodgkin's disease, it is extremely rare, with only a few cases reported in the literature. Significant results may be obtained with decompressive surgery and chemotherapy when the disease is promptly diagnosed. Spinal cord compression by primary Hodgkin's disease is a very infrequent situation. We urge this diagnosis be considered in all patients presenting with spinal cord compression attributed to malignancy.

[Angiolymphoid hyperplasia with eosinophilia]. / Hyperplasie angiolymphoïde à éosinophiles.

INTRODUCTION: Angiolymphoid hyperplasia with eosinophilia is a rare affection. CASE REPORT: A 36 years-old woman presented an angiolymphoid hyperplasia with eosinophilia manifesting by erythematous nodular lesions on the face and the forearms, severe neuropathy, visual loss and eosinophilia. Corticosteroids, immunosuppressive drugs and interferon-alpha were unsuccessful. DISCUSSION: Angiolymphoid hyperplasia with eosinophilia is a dermatological disease with possible systemic features. Differential diagnosis with Kimura disease is based on clinical presentation and histological findings. Etiopathology remains unknown and the treatment is not codified.

[Non-Hodgkin's lymphoma and hepatitis C virus infection]. / Lymphomes non hodgkiniens et infection par le virus de l'hépatite C.

INTRODUCTION: The authors report four cases of non Hodgkin's lymphomas (NHL) among patients infected by the hepatitis C virus (HCV). They discuss the epidemiological, physiopathological and clinical features of this association. CURRENT KNOWLEDGE AND KEY POINTS: The role of the HCV in the development of B-cell NHL is probable but the reported frequency of the association with HCV infection is variable especially in different countries. Most of the reported cases are low-grade NHL with frequent extranodal involvement. FUTURE PROSPECTS AND PROJECTS: New studies will improve the understanding of the physiopathological mechanisms that might explain the occurrence of NHL in the course of HCV infection. The recent evidence that the antiviral treatment is effective in splenic lymphoma with villous lymphocytes leads to reconsider the relationship between HCV and NHL and to think about new therapeutic possibilities.

[Cardiac localization of non Hodgkin's lymphoma: a study on four cases]. / Localisations cardiaques du lymphome non hodgkinien: à propos de quatre cas.

INTRODUCTION: Cardiac localization of non-Hodgkin's lymphoma is rare and usually seen in the latest phase of the disease. However, its frequency is certainly under-estimated because 20% of patients who die of lymphoma have a heart involvement at autopsy. EXEGESIS: We report four cases of cardiac involvement of non-Hodgkin's lymphoma with various revelation modalities. Features of cardiac lymphoma are multiple and not specific. Echocardiography can be helpful in finding cardiac localizations, which can involve every cardiac structure. Histological proof of such an involvement is sometimes difficult to obtain. CONCLUSION: Prognosis of cardiac lymphoma remains poor despite the real progress in the treatment of lymphomas.

[Digestive malacoplakia]. / Malacoplakie digestive.

INTRODUCTION: Malacoplakia, a chronic granulomatous disease, rarely involves the digestive tube and, when it does, takes on a pseudotumoral aspect. OBSERVATION: A 37 year-old man was hospitalized for chronic diarrhea that had progressed over 15 years. He exhibited an edematous-ascitic syndrome and bilateral pleurisy together with, biologically, a malabsorption syndrome. The endoscopic examinations (fibroscopy and colonoscopy) revealed polypoid tumor-like formations. An image of tumoral stenosis of the sigmoid-colic junction was revealed on barite lavage. Histological examination of the surgical sample (wide left colectomy of one third of the transverse) was suggestive of malacoplakia (histiocytes with characteristic Michaelis-Gutmann bodies). DISCUSSION: Malacoplakia is an inflammatory disease predominantly affecting the urogenital tract. Other organs can be involved. Its clinical symptomatology is highly disparate. The interest of this disease is in its pathogenesis, on which, in fact, its treatment is based.