Symptomatic hypercalcemia and lytic lesions of the skull revealing sarcoidosis: A case report.

Sarcoidosis is a systemic granulomatosis of unknown etiology. Mediastinal lymph node and pulmonary involvement are the most characteristic manifestations. However, bone involvement is rare during sarcoidosis. Herein, we describe an atypical case of sarcoidosis revealed by a severe hypercalcemia and lytic lesions of the skull without pulmonary or mediastinal manifestation. A 53-year-old woman was admitted for symptomatic hypercalcemia of 3.8 mmoL/L. The initial good course after hydration combined with a dose of intravenous zoledronate was followed by a relapse of hypercalcemia. Computed tomography (CT) scan showed 2 lytic lesions of the skull and multiple nodules and micronodules in the liver and the spleen which were of normal size. The histological examination showed a non-necrotizing granulomatous hepatitis, with no signs of malignancy. The bone marrow biopsy did not show any abnormality. Assessment for tuberculosis was negative. The diagnosis of sarcoidosis was considered. Oral prednisone therapy allowed total remission.

Focal pyomyositis caused by Enterobacter in an immunocompetent patient: A case report.

Pyomyositis is a pyogenic infection of skeletal striated muscle, usually found in tropical areas, often in immunocompromised patients. We report a new observation of a nontropical Enterobacter pyomyositis occurring in an immunocompetent female in Tunisia. A 53-year-old patient presented with acute fever and intense myalgia in the right thigh. On clinical examination she had an altered general condition, a fever at 40°C and an important swelling of the lateral side of the right thigh. In biology, she had an inflammatory syndrome. Blood culture had identified Enterobacter. Muscle magnetic resonance imaging showed diffuse inflammatory involvement of the vastus lateralis muscle of the right quadriceps associated with edematous infiltration of subcutaneous fatty tissues. Diagnosis of pyomyositis was retained. Antibiotic therapy initially probabilistic and then adapted to the antibiogram was initiated with a favorable outcome. Although rare outside the tropics, the potential severity of pyomyositis encourages its better knowledge.

[Pseudotumor cerebri revealing sarcoidosis]. / Pseudotumeur cérébrale révélant une sarcoïdose.

Sarcoidosis is a multivisceral granulomatosis of unknown aetiology which may have various clinical and radiological manifestations. Cerebral sarcoidosis, although rare, can appears as a misleading pseudotumor. We report the case of a young Tunisian adult hospitalized for intracranial hypertension associated with pseudotumoral lesion on radiology, which was revealed to be systemic sarcoidosis.