[Rotary C1-C2 dislocation: a case report]. / La luxation rotatoire C1-C2 : à propos d'une observation.

The atloid-axoid rotatory slipped disc is a rare pathology with still uncertain etiology. Many situations can be factors of this disease. We report a case in a child who was admitted to the hospital for a stiff neck that had been evolving for 1 month. The clinical examination found an irreducible angular deformity of the neck and multiple cervical adenopathies. The ORL examination was normal, the biological tests showed no disorders, and the X-ray examinations were also normal. Unexpected admission features were also disconcerting. The child suddenly presented a stiff neck on waking 2 days after a traditional circumcision at home, which might have been traumatizing. The mother also reported fever a few days before, attributed to rhinopharyngitis. Before his referral to the Rabat Children's Hospital, the child had received an anti-inflammatory treatment without any improvement. He had also been considered to have an opisthotonos on admission and was treated for suspected tetanus. Finally, the rotatory dislocation of C1-C2 was suggested, and a cervico-occipital junction scanner with three-dimensional reconstructions confirmed the diagnosis. The child was treated with cranial traction with good progression. This case opens the discussion of this rare disease, often unrecognized, which requires a multidisciplinary approach.

[Sclerosing cholangitis revealing Langerhans cell histiocytosis in a 15-month-old child]. / Cholangite sclérosante révélatrice d'une histiocytose langerhansienne chez un nourrisson de 15 mois.

INTRODUCTION: Langerhans cell histiocytosis (LCH) is a rare disease that mainly affects young children. Sclerosing cholangitis may occur in 10-15% of patients with the multivisceral form. We report the case of a 15-month-old child who presented sclerosing cholangitis revealing LCH. OBSERVATION: A 15-month-old child was hospitalized for cholestatic jaundice. He was the son of consanguineous parents and had repeated ear infections. One month before his hospitalization, he developed febrile jaundice. Initial clinical examination showed hepatosplenomegaly, with cholestasis, bicytopenia, and biological inflammatory syndrome. The digestive radiological studies revealed hepatomegaly and a regular thickening of the intestinal wall with an extension to the biliary tree. During his hospitalization, the infant developed stubborn ascites, lymphadenopathy, and skin lesions. Skull radiographs revealed punched-out lesions. The skin biopsy confirmed the diagnosis of histiocytosis X. Chemotherapy was started. The child died after the first course of treatment as a consequence of liver failure. CONCLUSION: Sclerosing cholangitis may complicate LCH, mainly in its multivisceral form. On average, sclerosing cholangitis develops 2 years after diagnosis in children. It is rarely indicative of the diagnosis, which is mainly based on radiological examinations. Liver involvement is a factor of poor prognosis. It precipitates the occurrence of biliary cirrhosis. Usually, sclerosing cholangitis responds poorly to Langerhans histiocytosis treatment and liver transplantation must be considered.

[A severe form of urinary tuberculosis in children]. / Forme grave de la tuberculose urinaire chez l'enfant.

Urinary tuberculosis is a rare disease in children. It poses major diagnostic problems because of clinical symptoms, which are often atypical and misleading. It causes serious lesions which are often multifocal and extensive, requiring complex surgical excision and urinary tract reconstruction. Prevention of this disease is based on generalized vaccination with BCG and adequate treatment of pulmonary tuberculosis. The authors report a case of urinary tuberculosis in a fourteen-year-old child who presented episodes of cystitis and hematuria refractory to treatment. The diagnosis, confirmed by the positive test for AFB in the urine was established late, at the stage of silent kidney and scleroatrophic bladder. The patient was treated with antituberculous chemotherapy (Isoniazid; Rifampicin, PZA) and nephro-ureterectomy with augmentation enterocystoplasty.