Destructive polyarthritis due to a group B streptococcus.

A new case of destructive polyarthritis due to a Group B streptococcus is reported. The patient was a 55-year-old male whose predominantly axial manifestations in the absence of evidence of an infection initially suggested psoriatic arthritis. Although rare, Group B streptococcal arthritis has been reported outside the postpartal and neonatal periods. Monoarthritis with a favorable outcome has been the most common clinical pattern. Several cases of destructive polyarthritis with axial involvement have been reported in which the joint destruction and longer time to diagnosis as compared with monoarticular forms resulted in permanent functional impairment.

Late onset spondylarthropathy: clinical and biological comparison with early onset patients.

OBJECTIVE: To compare the clinical, radiological, and biological profile of patients presenting late onset spondylarthropathy (LOSPA) with patients with early onset spondylarthropathy (EOSPA). METHODS: During the period April 1987 to April 1995 a retrospective chart review of inpatients and outpatients identified eight patients with LOSPA. They were matched with 32 patients with EOSPA examined during the same period of time. Clinical, radiological, and biological signs were compared. All patients fulfilled Amor criteria for spondylarthropathy. RESULTS: Mean age of patients with LOSPA was 65.1 years (range 58-72), and 26.6 years (range 11-40) in patients with EOSPA. The sex ratio (female/male) was 5/3 in LOSPA and 9/23 in EOSPA (p = 0.007). Patients with LOSPA had more significantly cervical and dorsal pain (p = 0.002, p = 0.02 respectively), anterior chest wall involvement (p = 0.04), number of peripheral arthritis (p = 0.04), aseptic osteitis (p = 0.004), and systemic symptoms: fever, fatigue, weight loss (p = 0.04). Mean (SD) erythrocyte sedimentation rate was 87 (24) in LOSPA and 24 (35) in EOSPA patients (p = 0.001). Inflammatory bowel disease was diagnosed in three patients with EOSPA. A definite family history of SPA was found in 50% of patients with LOSPA and in 31% of patients with EOSPA. A clear response to NSAID was obtained in 62% of LOSPA patients and in 90.6% of EOSPA patients (p = 0.05). Three LOSPA patients (two with Crohn's disease) not responding to NSAID were successfully treated with prednisone. CONCLUSION: The onset of spondylarthropathy is uncommon after 55 years. Patients with LOSPA, according to accepted international criteria present a different clinical and biological profile when compared with younger patients. These results suggests that age may influence the presentation of SPA at onset.

Facial edema and giant cell arteritis.

Many atypical manifestations that can be inaugural in giant cell arteritis are well known. Three cases with facial edema as the first manifestation are described. Similar cases reported to date are reviewed.

[Sarcoidosis and leukemia/T-cell lymphoma associated with HTLV-1 virus infection in adults (apropos of a case)]. / Sarcoïdose et leucémie/lymphome T de l'adulte associées au virus HTLV-I (à propos d'une observation).

The HTLV-1 virus causes a disturbance of the immune system, the evaluation of which is often difficult. We report a case of sarcoidosis in a 49 year old woman of Martinique as evidenced by bilateral hilar adenopathy, hypercalcaemia, uveitis and granulomatous lesions on histological examination. Serological was positive for HTLV-1 antibodies. Three years later she developed an adult T-cell leukemia/lymphoma. The relationships between the HTLV-1 retroviral infection and different pathologies observed are discussed.