[Primary tuberculous abscess and pyogenic psoas abscess: an uncommon association]. / Abcès primaire tuberculeux et à pyogène du psoas: une association exceptionnelle.

Psoas abscesses account for 5-10% of abdominal suppurations. They can be primary or secondary. Primary polymicrobic abscesses of the psoas muscle including, in particular, tuberculous abscesses and pyogenic abscesses, have never been reported in the literature. We report the case of a 35-year old patient, with no particular past medical history, admitted with pain in the right lumbar fossa associated with a fever of 40°C. Onset of symptoms had occurred 5 months before, but without fever. Abdominal CT scan showed an abscess of the right external transverse and oblique psoas muscles extended to the retroperitoneum and infiltrating the thoracoabdominal wall. Cytobacteriological examination of pus showed fast-growth monomorphic wild-type Escherichia coli strains. Systematically performed Real-time PCR test for the detection of Complex Mycobaterium tuberculosis was positive while direct examination after Ziehl-nelseen staining was negative. The culture on a solid Lowenstein Jensen medium was positive after one-month of incubation. The outcome of our patient was favorable under antibacillar quadritherapy and ceftriaxone. This study highlights that a tuberculous origin should be systematically suspected in patients living in endemic areas with chronic, recurrent psoas abscess not responding to antibiotics.

[Granulomatous spondylodiscitis: due mainly to tuberculosis but lymphoma cannot be excluded]. / Spondylodiscite granulomateuse: surtout la tuberculose mais ne pas omettre le lymphome.

Lower back pain is due to multiple etiologies that make diagnosis difficult. Primitive spinal lymphoma is rare and its diagnosis often requires ultrasound-guided biopsy. A 30-year old man hospitalized for inflammatory lumbago evolving within the context of an impaired general condition. Phisical examination revealed pain on palpation of the L2-L3 vertebral apophysis without peripheral tumor syndrome. Laboratory tests showed an inflammatory syndrome. Morphological assessment was in favour of a spondylodiscitis. The first biopsy showed granulomatous osteitis.Clinical and radiological worsening during antibacillary treatment led to reconsider the original diagnosis and a second biopsy confirmed the diagnosis of lymphoma. The diagnosis of skeletal tuberculosis in particular spinal tuberculosis requires bacteriological or histological confirmation in order not to overlook a primitive bone lymphoma.

[Peripheral neuropathy during Infliximab therapy: a case study]. / Neuropathie périphérique sous Infliximab: étude d'une observation.

Anti TNF alpha treatments are wide spectrum therapies. Multiple side effects have been reported in recent years, particularly peripheral neuropathies. We report a case of axonal neuropathy occurring three months after starting treatment with Infliximab. Our study focused on a 60-year old female patient treated for therapy-resistant hemorrhagic rectocolitis, requiring treatment with infliximab. Three months later, the patient had sensory axonal neuropathy. Etiologic assessment remained negative and dose reduction was accompanied by an improvement in symptoms. The time between initiation of treatment with Infliximab and the onset of clinical manifestations as well as improvement after dose reduction advocate the responsibility of infliximab in the occurrence of sensory neuropathy. Its management is not standardized and should be discussed case by case.

Acquired ichthyosis disclosing non-Hodgkin's malignant lymphoma.

When ichthyosis occurs in adulthood, it may signify internal disease, especially malignant hemopathy. A 49-year-old man was admitted to hospital with diarrhea, fever, weight loss and abdominal pain. Physical examination showed generalized ichthyosis with palmoplantar hyperkeratosis and multiple inguinal lymph nodes. Laboratory investigations showed severe pancytopenia. Ultrasonography and CT scan demonstrated intraabdominal lymph node enlargement. Osteomedullary biopsy and open abdominal lymph node biopsy revealed an anaplastic large cell lymphoma. The lymph node involvement subsequently became worse and more severe, and the patient's general condition deteriorated. He died before receiving chemotherapy.

[Acquired ichthyosis revealing hepatic and lymph node tuberculosis]. / Ichtyose acquise révélatrice d'une tuberculose hépatique et ganglionnaire.

INTRODUCTION: Acquired ichthyosis is an uncommon disease usually associated with different systemic diseases. Its characteristic clinical sign is symmetrical scaling of the skin. We report a case of acquired ichthyosis revealing hepatic and lymph node tuberculosis. CASE: A 41-year-old man was admitted to our hospital with weight loss and generalized acquired ichthyosis. Ultrasonography and computer tomography showed enlargement of abdominal lymph nodes. Lymph node and liver biopsy samples were taken during exploratory laparotomy and revealed multiple lymphoepitheliomas with Langhans-type giant cells and central caseous necrosis. The skin lesions resolved progressively after 5 months of antituberculous therapy. DISCUSSION: Ichthyosis occurring in adulthood is often a sign of internal disease, especially malignant conditions. It has also been associated with autoimmune and infectious diseases, sarcoidosis and drugs. It is only rarely reported among patients with tuberculosis but it is possible that the ichthyosis in this case was due to weight loss and deterioration of the patient's general condition.

[Sarcoidosis and ankylosing spondylitis. A case report and review of the literature]. / Sarcoïdose et spondylarthrite ankylosante. A propos d'un cas et revue de la littérature.

UNLABELLED: Ankylosing spondylitis is a very uncommon finding in patients with sarcoidosis. Thirteen cases have been reported in the literature. We report a new case. Observation. - A 40-year-old man had inflammatory low back pain since 1983 which formerly responded to nonsteroidal inflammatory drugs (NSAIDs). He developed dyspnea and skin rash in 1993. Physical exam found cervical and lumbar spine stiffness and violaceous and circular lesions on the forehead, nose and right cheek. Laboratory tests showed: ESR at 50 mm, increased serum angiotensin-1-converting enzyme, and negative HLA B27. X-rays showed sacroiliac ankylosis, cervical and lumbar syndesmophytes and cervical facet joint ankylosis. The plain chest x-ray showed an interstitial syndrome. Chest CT scan showed mediastinal adenopathies. Skin biopsy disclosed non-caseating epitheliod and giant-cell granuloma. Outcome was good with steroid therapy but back pain was only improved by NSAIDs. DISCUSSION: - This association raises a diagnostical problem because spine involvement in sarcoidosis can mimic ankylosing spondylitis. It also suggests the hypothesis of a pathophysiological link between the two diseases.