[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.

[Prostatic actinomycosis in a diabetic patient]. / Actinomycose prostatique chez un patient diabétique.

INTRODUCTION: Prostatic localization of actinomycosis is unusual. CASE REPORT: We report the case of a 59 years-old diabetic man, hospitalised for a prostatic actinomycosis spontaneously fistulised in the rectum. Two species of Actinomyces were found in blood culture and in pus of the fistula. DISCUSSION: Therapeutic management including surgical treatment of the fistula and a specific antibiotherapy led to cure the prostatic infection due to Actinomyces.

[Acquired, non-amyloid related factor X deficiency: A first case associated with atypical chronic lymphocytic leukemia and literature review]. / Déficit non amyloïde acquis en facteur X : un premier cas satellite d'une leucémie lymphoïde chronique atypique et revue de la littérature.

INTRODUCTION: Acquired factor X deficiency is in most cases associated with AL amyloidosis. Acquired non-amyloid related factor X deficiency (DNAA-FX) has been exceptionally reported in the literature. CASE REPORT: We report the first case of acquired, non-amyloid related factor X deficiency associated with atypical chronic lymphoid leukemia in a 66-year-old patient with spontaneous hematomas. After therapeutic failure with polyclonal intravenous immunoglobulins, specific lymphoid malignancy treatment allowed symptoms and coagulation disorder resolution. CONCLUSION: DNAA-FX should be considered in case of bleeding events or coagulation disorders during low-grade hematological malignancies. Its occurrence can be considered as a treatment indication to prevent potentially fatal bleeding complications.

[Early myocardial infarction associated with chemotherapy for testicular cancer]. / Infarctus du myocarde précoce après chimiothérapie pour tumeur testiculaire.

INTRODUCTION: In long-term survivors of testicular cancer, a greater risk of developing cardiovascular disease is reported. On the other hand, acute vascular event during chemotherapy is uncommon. CASE REPORT: We report on a case of acute myocardial infarction in a young man receiving chemotherapy (BEP) for testicular cancer. DISCUSSION: We suggest a causal association between chemotherapy and early myocardial infarction. The physiopathological mechanisms are discussed here.

[Acute abdominal pain in a 8-year-old girl with Epstein-Barr infection]. / Douleur abdominale aiguë au cours d'une primo-infection par le virus d'Epstein-Barr.

Abdominal pain is uncommon in patient with Epstein-Barr infection and is usually attributed to an enlargement of the liver or spleen. We report on an 8-year-old girl with a pseudoperitonitis due to a mesenteric lymphadenitis associated with Epstein-Barr infection. Outcome was favourable without surgery. We review the different causes of abdominal pain occurring during Epstein-Barr infection.

[Bing-Neel syndrome: Report of 4 cases and literature review]. / Syndrome de Bing et Neel : à propos de 4 cas et revue de la littérature.

INTRODUCTION: Neurological manifestations during Waldenstrom disease are common and are usually related to immune peripheral neuropathy or serum hyperviscosity syndrome. The infiltration of the central nervous system by the lymphoproliferative syndrome is known as the Bing-Neel syndrome. This extremely rare entity remains poorly described in the literature. CASE REPORTS: We report on 4 cases of patients for whom central neurological disorders led to the diagnosis of a Bing and Neel syndrome. These four cases illustrate different clinical presentations, diagnosis, therapeutic options, and outcome in this syndrome. Based on our literature review, we discuss about these differences. CONCLUSION: The polymorphic clinical manifestations of Bing and Neel syndrome can mimic many diagnoses. However, it may be necessary to consider this diagnosis. Cerebrospinal fluid analysis and MRI may allow rapid diagnosis or guide a biopsy. Prolonged remissions are possible with appropriate treatment.

[Spondylodiscitis disclosing endocarditis on the endocavitary electrodes of cardiac pacemakers]. / Spondylodiscites révélatrices d'endocardite sur électrodes endocavitaires de stimulateurs cardiaques.

Permanent pacemaker electrode infection is rare but can be fatal. The authors report two cases presenting with spondylodiscitis, a previously described mode of presentation of valve endocarditis but not previously reported in this context. In one case, recurrent courses of antibiotics did not prevent repeated episodes of bacteraemia. In the second, the relapse of infection occurred at different sites of the vertebral column until surgical removal of the electrodes: the usual features of this pathology were observed: frequent but not constant infection at the site of the pacemaker implantation, making the diagnosis more difficult; delayed signs of spondylodiscitis after implantation of the pacemaker; recurrence of infection when antibiotic therapy alone was prescribed and, therefore, the need for surgical ablation of all implanted material. The authors underline the diagnostic value of transoesophageal echocardiography.

[Left atrial thrombus in multiple myeloma treated with thalidomide]. / Thrombus de l'oreillette gauche au cours d'un myélome multiple traité par thalidomide.

The occurrence of a left atrial thrombus without a haemodynamic predisposing factor (arrhythmia, mitral valvulopathy, severe left ventricular dysfunction) is a rare event. We report a case during the progression of refractory myeloma, four months after stopping treatment with thalidomide. The promoting haemodynamic factors for left atrial thrombosis in sinus rhythm, described in the literature, had been excluded. In our case the potential role of thalidomide is debatable, in the light of recent publications about venous and arterial thromboses observed with this treatment.

[Primary melanoma of the esophagus]. / Mélanome primitif de l'oesophage.

The authors report 2 cases of primary melanoma of the esophagus, and describes the clinical, endoscopical, radiological and histological features from these exceptional tumors. Prognosis is very poor, despite various therapeutical possibilities.

[Meningoradiculitis revealing an occult medulloblastoma-PNET in an adult]. / Méningo-radiculite révélant un médulloblastome-PNET occulte de l'adulte.

Neoplastic meningitis as the presentation of occult primitive neuroectodermal tumor (PNET) is occasionally described in children. We report the case of an 64 year old-man who presented a meningo-radiculopathy with progressive injury of the cauda equina and then the ocular motor nerves, revealing an occult medulloblastoma-PNET.

[Immunodepression and pulmonary infections]. / Immunodépression et infections pulmonaires.

The acquired immunosuppressed states are increasingly numerous. Pneumopathies are a frequent, serious complication and etiologic diagnosis is often difficult. The nature of the micro-organism in question is a function of the immunizing type of deficiency. In neutropenias, the infections are primarily bacterial, their potential gravity being correlated with the depth of the deficiency into polynuclear, or fungic, especially in prolonged neutropenias. The aspleened states are responsible for a deficit of the macrophage system and contribute to the infections with encapsulated germs (pneumococci, klebsiellas...). The organic grafts imply an attack of cell-mediated immunity, in the particular case of the auxiliary T lymphocytes (CD4)), with a special predisposition for viral and fungic infections. During VIH infection, the immunizing deficit of CD4 lymphocytes worsens with time. At the early stage, the infections are especially bacterial. At the more advanced stages, the pulmonary pneumocystosis and tuberculosis dominate. At the late stage, finally, deep immunosuppression allows emerging of the atypical mycobacteries. In the deficiencies of humoral immunity (congenital hypogammaglobulinemias, lymphoid hemopathies B), the germs to be mentioned are the pneumococcus, Haemophilus influenzae, the salmonellas and the legionellas. Immunosuppressed pneumopathies are characterized by radio-clinical pictures of very variable gravity, ranging from focused acute pneumopathy to bilateral diffuse pneumopathy with acute respiratory distress syndrome, with phases of atypical tables with respiratory symptomatology larval or absent. The highlighting of the micro-organisms in question requires urgent complementary investigations: hemocultures, bronchiolo-alveolar washing. In certain cases, it will be possible to resort to the transtracheal puncture or transthoracic puncture guided by tomodensitometry, and if necessary to pulmonary biopsy under videothoracoscopy. Emergency of the anti-infectious treatment imposes, in general, a presumptive treatment directed according to the immunizing deficiency in question and etiologic suspicion. It will be associated, if necessary, with urgent measurements of respiratory intensive care.

[Cytomegalovirus myeloradiculitis in pregnancy]. / Myéloradiculite à cytomégalovirus au cours d'une grossesse.

INTRODUCTION: Cytomegalovirus neurological complications are frequent in immunocompromised patients specially in HIV positive patient. In immunocompetent patient these complications are infrequent. EXEGESIS: We describe a case of cytomegalovirus myeloradiculitis during pregnancy in a 25-year-old woman, HIV negative. The evolution was favorable with foscarnet therapy. CONCLUSION: A spinal complication during cytomegalovirus infection in immunocompetent patient should lead to a therapy with a specific antiviral to reduce neurologic involvement.

[Bone marrow aplasia related to ticlopidine]. / Aplasie médullaire associée à la ticlopidine.

The authors report two cases of bone marrow aplasia observed 2 months after initiation of a treatment with ticlopidine. The outcome was favorable after discontinuation of therapy. The frequency of this severe drug-induced complication seems to have been underestimated. The absolute necessity of a careful haematological survey during the first 3 months of therapy is pointed out.

[Isolation of viruses in the cerebrospinal fluid in a case of acute varicella meningo-encephalitis]. / Isolement du virus dans le liquide céphalo-rachidien dans un cas de méningo-encéphalite aiguë de la varicelle.

The authors report a case of severe, life-threatening, meningo-encephalitis occurring in a young nonimmunodepressed adult with varicella. The demonstration of a cytopathogenetic effect of his cerebrospinal fluid and of immunoglobulins M specific to the varicella-zoster virus was in favour of an acute, directly viral-dependent encephalitis rather than an immune-mediated leucoencephalitis, as used to be commonly admitted. This is an incitement to use acyclovir in such cases, the effect of which contributes to reinforce this pathogenic hypothesis.

[Acute Streptococcus salivarius meningitis after spinal anesthesia]. / Méningite aiguë à Streptococcus salivarius après rachianesthésie.

The case of a 50-year-old woman who experienced an acute Streptococcus salivarius meningitis after a spinal anaesthesia for hysteroscopy is reported. The contamination of the cerebrospinal fluid may occur from a puncture during a bacteriaemia. Contamination from the patient's skin and from the upper airway's flora of the operator seems to be a more plausible cause. Spinal anaesthesia is contra-indicated in the febrile patient. Asepsis is essential during spinal puncture, including wearing a surgical face mask.

[Patch-like sweat gland necrosis in AIDS]. / Nécrose sudorale en plaques au cours du SIDA.

Hard plaques located in pressure areas were observed in an HIV-infected male patient at the AIDS stage. Histological examination of the skin showed necrosis of the eccrine sweat glands. The relationship between this disease and eccrine neutrophilic hidradenitis observed in HIV infection is discussed. The authors propose a concept of eccrine sweat gland lesion spectrum.

[Panniculitis-fasciitis syndrome disclosing systemic erythematous lupus]. / Syndrome panniculite-fasciite révélant un lupus érythémateux systémique.

INTRODUCTION: Panniculitis is a common manifestation of lupus, but is rarely the first manifestation in systemic lupus erythematosus. We report a case associated with fasciitis. CASE REPORT: A 67-year-old man was hospitalized for fever, pleuropericarditis, subcutaneous diffuse infiltration of the two thighs and the abdomen due to panniculitis and lupic fasciitis. Antiphospholipid antibody test was positive. There was non antiphospholipid syndrome. COMMENTS: Panniculitis can occur simultaneously or a few months or years before systemic lupus erythematosus. An association with fasciitis should be entertained whenever the cutaneous involvement is extensive and firm. In such a situation, deep biopsies are indicated. Observations of further cases will help identify the role of general steroid therapy in fasciitis-panniculitis and systemic lupus erythematosus.

[Leishmaniasis and human immunodeficiency virus: an emerging co-infection?]. / Leishmaniose et virus de l'immunodéficience humaine: une co-infection en émergence?

Although not considered as indicative of AIDS, leishmaniasis presents a number of epidemiologic and clinical features that promote opportunistic infection in HIV patients. Accurate assessment of the incidence of this type of co-infection is difficult due to underestimation in endemic areas such as Africa and Asia. In these areas the WHO estimates that 2 to 9 p. 100 of HIV patients will develop leishmaniasis/HIV co-infection which could become a major concern. The characteristics of this co-infection have been documented. It is observed in adults between 20 and 40 years of age with a strong male sex bias. The visceral form is most frequent. Manifestations are similar to those observed in immunocompetent subjects but with the possibility of asymptomatic and low-grade forms (10 p. 100) and unusual locations suggesting multiorgan spreading in absence of host immune response. In addition to the time-tested standard procedures for diagnosis of parasitic disease, new serologic tests and genomic amplification are now available. Pentavalent antimonials have long been considered as the treatment of choice but they are not always effective and can have untoward effects. Amphotericine B especially in the liposomal form is a good alternative. The particularly high incidence of recurrence suggests that follow-up may be indicated but the modalities of prophylaxis have yet to be defined.

[Can we prevent or cure infection-related cancers?]. / Peut-on prévenir ou guérir les cancers d'origine infectieuse?

Infections are an important cause of cancer in the world, representing approximately 16% of the neoplasia. Ten infectious agents have been classified as carcinogens of group I. Four of these pathogens (Helicobacter pylori, hepatitis B and C viruses, and some human papillomavirus) are responsible for 95% of cases of infection-related cancers. The carcinogenesis mechanisms are multiple, either direct via certain proteins from these microorganisms, or more often indirect through chronic inflammation. This allowed to consider prevention of certain cancers, for example with a prophylactic vaccine strategy. Advances were also made in the curative field. However, efforts remain to be done to discover new infectious causes of cancer and refine the understanding of the mechanisms of carcinogenesis, for a better targeting of anticancer therapeutics.