[Extensive bone marrow necrosis as presenting manifestation of sickle cell disease in Africa]. / Necrose médullaire etendue en Afrique révélant une drépanocytose homozygote.

Extensive bone marrow necrosis is a rare but severe complication of sickle cell disease. A formerly healthy man was admitted for bone pain, fever, and jaundice with severe aregenerative anemia. Bone marrow aspiration and biopsy showed extensive bone marrow necrosis while hemoglobin electrophoresis demonstrated homozygotic sickle cell disease. Despite early onset of septic arthritis of the right shoulder, outcome after blood transfusion and nonspecific treatment was favorable. Six months later, hemoglobin level remained stable up to 97 g/L. This first African case report illustrates typical features and good prognosis of extensive bone marrow necrosis in sickle cell disease. Extensive bone marrow necrosis is a highly unusual presenting manifestation of sickle cell in an adult.

[Concurrent mycetoma and chromomycosis: case report from Senegal]. / Association d'un eumycétome et d'une chromomycose: une observation au Sénégal.

A 68-year-old cattle farmer from northern Senegal sought medical attention for tumefaction that had been progressing on the right foot and leg for 20 years. Physical examination of the right extremity revealed very firm tumefaction involving the foot and whole leg associated with numerous nodules. Bone radiographs and CT-scan of the foot and leg disclosed extensive osteolytic involvement. A specimen of squamous tissue from the top of nodules showed the presence of fumagoid cells characteristic of chromomycosis. Histologic examination after skin biopsy demonstrated fungal myocetoma. Due to the extent of involvement surgical and antifungal treatment was proposed but the patient refused to undergo surgery. Only one previous case of concurrent chromomycosis and mycetoma has been described. However the previous case involved actinomycetoma. The rarity of this combination of diseases despite their common contamination mode is due to different geographical distribution with mycetoma being found in the Sahelian region and chromomycosis in the humid equatorial region.

[Clinical overview of New World tegumentary leishmaniasis]. / Panorama clinique des leishmanioses tégumentaires du Nouveau Monde.

This richly illustrated article (80 color photographs) based on the authors' experience in French Guyana documents the clinical diversity of American tegumentary leishmaniasis. Main highlights include the often outstanding aspect of lesions, the high frequency of forms not associated with ulceration or scab formation that must be recognized to achieve diagnosis in travellers returning from endemic zones, and the special prognosis of clinical forms associated with intradermic, lymphatic or hematogenous spread. The article also reviews an original diagnostic method based on culture of cutaneous biopsy specimens on specific nutrient mediums that provides isolates in a high percentage of cases (80%) and thus allows identification of offending parasite.

[Cerebromeningeal listeriosis associated with a cytolytic hepatitis. First case report in Senegal]. / Listériose cérébro-méningée associée à une hépatite cytolytique. A propos de la première observation sénégalaise.

Hepatitis due to Listeria monocytogenes is uncommon in adults. This report describes the first case observed in Senegal. The patient was a 73-year old man presenting listeria-related hepatitis presumably secondary to low-grade meningeal encephalitis. Treatment using ampicillin was unsuccessful and the patient died four days after hospitalization. The authors note that the incidence of adult listeriosis has risen constantly for the past twenty years in relation with alcohol abuse, cirrhosis, diabetes, kidney insufficiency, cancer, AIDS, and organ transplantation. However no predisposing factors were observed in the present case.

[Pleuropulmonary manifestations of salmonellosis]. / Les manifestations pleuropulmonaires des salmonelloses.

Salmonella infections are widespread particularly in tropical zones. Each year, 12.5 million cases of typhoid fever are reported with an incidence of 540 cases for every 100,000 inhabitants in developing countries versus 0.2 cases in industrialized countries. Pleuropulmonary manifestations constitute the most common extra-intestinal manifestation of salmonella infection. Counts are usually carried out in the digestive tract. Respiratory tract manifestations result from blood-borne diffusion from mesenteric lymph nodes, but gastroenteritis goes unnoticed in 2 of 3 cases. Predisposing factors are frequent including cancer, previous graft placement and immunosuppressant therapy, sickle cell disease, alcohol abuse, and pre-existing pulmonary disease. Clinical manifestations are usually acute but subacute forms cannot be ruled out. Cough is a common symptom observed in 25% of patients with typhoid fever. Pneumonia is uncommon overall (1%) but occurs in 50% of patients with pleural effusion, empyema, lung abscess, or bronchopleural fistula. A few cases of adult respiratory distress syndrome have been described in the literature. Recognition is important since these manifestations may signal previously unsuspected underlying pulmonary disease. Treatment requires appropriate antimicrobial therapy and close surveillance to prevent recurrence or complications.

[Cytokines and malaria. A study of TNF-alpha, IL1-beta, IL6 and IL2R in 28 patients]. / Cytokines et paludisme. Etude du TNF alpha, de l'IL1 bêta, de l'IL6 et du RIL2s chez 28 malades.

Authors have studied TNF alpha, IL1 bêta, IL6 and RIL2s in 28 malaria illness patients. Increased levels of TNF, IL1 bêta and RIL2s in serum, are observed on admission to hospital. These cytokine levels are decreased, eight days later, after patients are treated. In discussion, TNF levels as a prognosis component is evocated.

[Bone localizations disclosing Hodgkin's disease. Apropos of 11 cases]. / Localisations osseuses révélatrices de la maladie de Hodgkin. A propos de 11 observations.

The authors report 11 cases of Hodgkin's disease in which the first sign was due to bone involvement. Such observations are rare and raise diagnosis delays (Means: 5, 6 months in this series). Modern medical imaging techniques (scintigraphy, CT scan, magnetic resonance imaging) are very useful to an earlier diagnosis which will be better confirmed by lymph node biopsy given the poor information yielded by osseous cytology and/or histology. The elective localisation in bones belonging to the axial skeleton seems to support the hypothesis of a contiguous osseous involvement from lymphoïd organs in contact with bones. Evolution with chemotherapy and radiotherapy is very similar to that observed in patients without bone involvement.

[Healthy and pseudo-healthy carriers of hepatitis B virus. A comparative clinical, biological and pathological approach]. / Porteurs sains et "pseudo-porteurs sains" du virus de l'hépatite B. Approche clinique, biologique et histologique comparée.

From a series of 100 patients hospitalized for chronic hepatitis B infections (HBV), 51 chronic carriers of the HBs antigen without elevated aminotransferases or circulating HBV DNA were studied retrospectively. They had no unusual epidemiological or clinical features compared to the other patients, but were distinguished by their normal liver function tests, except for 5 cases of isolated hypergammaglobulinemia. Hepatic biopsies performed on 28 patients showed minor lesions or normal tissue in 61% of the cases and persistent chronic hepatitis (PCH) in 39% of them. No clinical or biological abnormality was significantly associated with PCH, which was attributed to a delta hepatitis (HDV) superinfection in only one case. There were no cases of active chronic hepatitis or cirrhosis. The significance of the histological lesions in the absence of HBV replication or other symptoms of hepatocyte aggression was not elucidated; their longterm prognosis is not known even if no other difference, identifiable by usual methods, seems to exist between these "pseudo-healthy" carriers and real healthy carriers of HBV.

[Pulmonary manifestations of malaria]. / Les manifestations pulmonaires du paludisme.

Pulmonary edema is a classic and severe manifestation of falciparum malaria. To evaluate the predictive factors of this severe complication, we studied epidemiological, clinical and biological data of 136 patients with acute malaria. Two groups were individualized according to the presence (group I = 53 patients) or the absence (group II = 83 patients) of pulmonary manifestations. Pulmonary signs incidence was not correlated with impairement consciousness, creatinemia, hypoglycemia, and coagulation abnormalities. However, age, tobacco abused, delay in starting treatment, oliguria, decreased protidemia were significantly increased. These factors, associated with severe malaria, expose to a more important risk of pulmonary edema, often induced by reanimation management.

[Digestive disorders in histoplasmosis. Report of a case of ulcerous enterocolitis caused by Histoplasma capsulatum (author's transl)]. / Les manifestations digestives des histoplasmoses. A propos d'un cas d'entérocolite ulcéreuse à Histoplasma capsulatum.

Report of a new American histoplasmosis caused by Histoplasma capsulatum in a young adult Haitian, and review of the digestive disorders as reported in the previous medical papers. In the present case, the first localization detected was a granulomatous hepatitis which lead to the disclosure of an ulcerous entercolitis. Tuberculosis and Crohn disease were first suspected, but their treatment induced a worse turn of the patient's condition and compelled to a laparotomy, which shown ulcerous entercolitis with associated lymph-nodes. Per operative pathological examination gave evidence of Histoplasma capsulatum yeasts. Treatment, first with miconazole and later on with amphotericin B could not prevent the death of the patient affected by a deficiency of cell mediated immunity. Disseminated histoplasmosis is rare: 1 out of 5,000 cases of American histoplasmosis-digestive disorders are generally detected by surgery or post-mortem examination. They occur in 20 p. 100 of the cases envolving the whole digestive tract from mouth to anus, giving mucous ulcerations, difficult to detect by X ray. Endoscopic control with biopsies has therefore a great value. In Histoplasma duboisii, histoplasmosis digestive disorders are very unusual and localized to intestine. They may be detected by surgery, or by endoscopies. In the reported case, in spite of the geographical origin of the patient, the diagnosis of American histoplasmosis was not retained because of the negativity of the immunological tests and of the biopsies performed before surgery. An afterward checking of these biopsy specimens gave evidence of a few yeasts. Special dyeing technique may have made the diagnosis somewhat earlier; this is important because new non toxic imidazole drugs seem to be active against these yeasts.