[Third degree atrio-ventricular blockade during a myocarditis occurring under anti-PD1 : Case report and literature review]. / Bloc atrio-ventriculaire de grade III compliquant une myocardite au décours d'un traitement par anti-PD1 : observation d'un cas et revue de la littérature.

INTRODUCTION: Immune Checkpoint Inhibitor (ICI) therapy is now a standard of care in numerous cancers with very promising results. Nevertheless, adverse events, and especially immune-related adverse events (irAEs) not reported during clinical trials, are emerging and can be life-threatening. OBSERVATION: We report here a teachable case of a 80 year-old man, of third-degree atrioventricular block consecutive to myocarditis associated with the administration of nivolumab (anti-PD1) monotherapy. CONCLUSION: Myocarditis occurring during ICI treatment is a rare but potentially lethal event. Daily serum troponin level seems to predict ICI-related myocarditis but interpretation could be difficult in the context of associated myositis. Echocardiography and cardiac MRI are also useful but can remain negative. Electrocardiogram is a cornerstone of myocarditis diagnosis. In case of cardiac involvement, continuous heart rhythm monitoring should be performed in addition to the administration of high-dose corticosteroids therapy and the cessation of ICI therapy. Add-on treatments should be discussed with a well-trained multidisciplinary team.

Spontaneous splenic rupture: an uncommon complication of cytomegalovirus infection.

A previously healthy 25-year-old man developed a spontaneous rupture of the spleen during a cytomegalovirus (CMV) infection. The only other clinical feature was a well tolerated fever of 37.5 degrees C to 39 degrees C during the month before. The diagnosis was confirmed by the presence of IgM antibodies to CMV in the serum and by typical intranuclear inclusions for CMV identified by splenic histopathological findings. The patient recovered completely. Spontaneous splenic rupture is uncommon in primary cytomegalovirus infection.

[Helicobacter heilmannii ulceronecrotic acute gastritis: apropos of 5 cases ]. / Gastrite aiguë ulcéronécrotique à Helicobacter heilmannii: à propos de 5 cas.

We report 5 cases of Helicobacter heilmannii associated ulceronecrotic gastritis in patients presenting with acute epigastric pain. These bacteria were known to be associated with chronic active gastritis, less severe than those associated with Helicobacter pylori. Helicobacter heilmannii appears as spiral shaped organisms larger and longer but less numerous than Helicobacter pylori. Our five patients were cured by 4 weeks treatment with proton-pomp inhibitors without antibiotics. Endoscopic control, done in 4 patients, showed a complete cure and eradication of the germ. No ulcer relapse had occurred.

[Significance of antimitochondrial antibodies. In a population of 111 patients from the Midi-Pyrenees region]. / Signification des anticorps anti-mitochondrie. Dans une population de 111 malades issus de la région Midi-Pyrénées.

The aetiological significance of antimitochondrial antibodies (anti-M) being debated, we conducted an aetiological study of 111 sera with anti-M2 antibodies from patients living in the Midi-Pyrénées region (South-West France); these anti-M2 antibodies had been detected in the years 1984-85. Fifty-nine percent of the patients had primary biliary cirrhosis (41 p. 100 were asymptomatic, and 6 p. 100 had normal liver function tests). Anti-M2 antibodies at a titer of 1/500 or more were significantly more frequent among these patients as compared with the others (P less than 0.001, probability = 0.73). Six percent of the patients had chronic active hepatitis. The incidence of primary biliary cirrhosis could be estimated at 8.5 per 10(6) people per annum. In this patient population, primary biliary cirrhosis was more common than all other causes of anti-M2 antibodies, and an anti-M2 titer of 1/500 or more had a 73 p. 100 predictive value for that disease. In the region concerned the incidence of primary biliary disease was higher than previously reported in Western Europe.

[Metastatic obstruction of the small bowel revealing or complicating squamous-cell lung cancer. Two cases and a review of the literature]. / Occlusion métastatique de l'intestin grêle révélant ou compliquant un carcinome épidermoïde bronchique. Présentation de deux cas et revue de la littérature.

Gastrointestinal metastasis from lung cancer is exceptional and generally asymptomatic. Other secondary localizations are often present. Metastastic dissemination may involve any portion of the gastrointestinal tract. Clinical expression is variable: dysphagia, anemia, bowel obstruction, peritonitis. Surgical treatment may be indicated in selected patients. We describe the cases of two patients who developed obstruction of the small bowel due to metastases from squamous-cell lung cancer. Bowel obstruction was in the inaugural sign in the first patient. Mesenteric metastasis was associated in the second patient.

[Intra-thymic localization of a cystic multi-tissue mature teratoma]. / Localisation intra-thymique d'un tératome mature pluritissulaire kystique.

The authors report a case of mediastinal tumour in a child, corresponding to a teratoma arising in the thymus, an original site for this lesion classically observed in children.

Concurrent herpes simplex type 1 necrotizing encephalitis, cytomegalovirus ventriculoencephalitis and cerebral lymphoma in an AIDS patient.

Unlike cytomegalovirus (CMV) ventriculoencephalitis, herpes simplex virus type 1 necrotizing encephalitis has only rarely been observed in AIDS patients. A 40-year-old bisexual man was followed for an HIV1 infection from 1987 onwards. In June 1993 he was referred for sudden confusion, left hemiparesia and fever. The blood contained less than 10 CD4 lymphocytes/mm3. The patient remained comatose and febrile, and died 4 weeks later. In coronal sections of the brain there was necrosis of the internal parts of the left temporal lobe, necrosis of certain areas of the ventricular walls and a small tumor at the top of the right frontal lobe, which proved to be a polymorphic high-grade lymphoma. CMV ventriculoencephalitis lesions were prominent in the ventricular walls of the occipital lobes and there was a strong nuclear signal for CMV using in situ hybridization. Herpes simplex virus type 1 was shown in the nuclei and cytoplasm of certain neurons and astrocytes in the borders of the necrotized temporal lobe areas by immunohistochemistry, in situ hybridization and electron microscopy, whereas in situ hybridization and immunohistochemistry for CMV were negative in such areas. Necrotizing type 1 encephalitis must not be overlooked in immunodeficient patients.