An atypical case of Whipple's disease presenting as fever of unknown origin: A brief review.

A 59-year-old woman with epilepsy was admitted to hospital with a 6-year history of fever of unknown origin (FUO). Computed tomography (CT) showed extensive low-attenuation mesenteric and retroperitoneal lymphadenopathy. Investigations for malignancy and infection were negative, including two separate excisional biopsies of lymph nodes. An ascending aortic aneurysm was seen on CT, and a diagnosis of large vessel vasculitis (LVV) was considered. A trial of prednisone for presumed LVV was initiated and then discontinued when positron emission tomography (PET) failed to show vasculitis. Repeat core biopsy of a mesenteric lymph node revealed non-necrotizing granulomatous inflammation and histiocytes with periodic acid-Schiff (PAS)-positive intracellular material. Electron microscopy and polymerase chain reaction (PCR) of the tissue confirmed Tropheryma whipplei. She was treated with ceftriaxone for 2 weeks, followed by long-term combination doxycycline and hydroxychloroquine. The patient's seizure control improved on therapy, raising the suspicion that the seizure disorder was due to Whipple's disease.

Résumé : Une femme de 59 ans atteinte d'épilepsie a été hospitalisée parce qu'elle faisait de la fièvre d'origine inconnue depuis six ans. La tomodensitométrie a révélé une lymphadénopathie mésentérique et rétropéritonéale étendue, à faible atténuation. Les explorations de tumeurs et d'infections ont été négatives, y compris deux biopsies-exérèses distinctes des ganglions lymphatiques. Les chercheurs ont observé un anévrisme aortique ascendant à la tomodensitométrie et ont envisagé un diagnostic de vasculite de gros vaisseaux (VGV). Ils ont amorcé un essai de prednisone pour traiter la VGV présumée, puis ont arrêté le traitement lorsque la tomographie par émission de positrons ne l'a pas confirmée. La reprise de la microbiopsie d'un ganglion lymphatique mésentérique a démontré une inflammation granulomateuse non nécrosante et des histiocytes positifs à du matériel intracellulaire par coloration PAS périodique. La microscopie par électrons et l'amplification en chaîne de la polymérase (PCR) des tissus a confirmé la personne d'un Tropheryma whipplei. La patiente a reçu un traitement de deux semaines à la ceftriaxone, suivi d'une association de doxycycline et d'hydroxychloroquine à long terme. Le contrôle de ses convulsions s'est amélioré grâce à la thérapie, laissant soupçonner que son trouble convulsif serait causé par la maladie de Whipple.

Brief electrical stimulation improves nerve regeneration after delayed repair in Sprague Dawley rats.

Functional recovery after peripheral nerve injury and surgical repair declines with time and distance because the injured neurons without target contacts (chronic axotomy) progressively lose their regenerative capacity and chronically denervated Schwann cells (SCs) atrophy and fail to support axon regeneration. Findings that brief low frequency electrical stimulation (ES) accelerates axon outgrowth and muscle reinnervation after immediate nerve surgery in rats and human patients suggest that ES might improve regeneration after delayed nerve repair. To test this hypothesis, common peroneal (CP) neurons were chronically axotomized and/or tibial (TIB) SCs and ankle extensor muscles were chronically denervated by transection and ligation in rats. The CP and TIB nerves were cross-sutured after three months and subjected to either sham or one hour 20Hz ES. Using retrograde tracing, we found that ES significantly increased the numbers of both motor and sensory neurons that regenerated their axons after a three month period of chronic CP axotomy and/or chronic TIB SC denervation. Muscle and motor unit forces recorded to determine the numbers of neurons that reinnervated gastrocnemius muscle demonstrated that ES significantly increased the numbers of motoneurons that reinnervated chronically denervated muscles. We conclude that electrical stimulation of chronically axotomized motor and sensory neurons is effective in accelerating axon outgrowth into chronically denervated nerve stumps and improving target reinnervation after delayed nerve repair. Possible mechanisms for the efficacy of ES in promoting axon regeneration and target reinnervation after delayed nerve repair include the upregulation of neurotrophic factors.

Characterization of heterotopic ossification in burn patients.

Heterotopic ossification (HO) is a clinical condition of ectopic bone formation in soft tissue. This clinical entity has been associated with genetic disorders, traumatic injuries, and musculoskeletal surgeries. In this regard, functional impairments secondary to scar contractures seen in burn injuries may be exacerbated with underlying HO. The appropriate prevention or management of this complication is crucial to optimize outcome in burn patients. This clinical study reviews the incidence of HO in our burned patients, diagnostic methods, therapeutic approaches including surgical timing and techniques.