Cardiac tamponade: an uncommon presenting feature of systemic lupus erythematosus (a case-based review).

Although pericarditis is the most prevalent cardiac involvement in systemic lupus erythematosus (SLE), cardiac tamponade is extremely infrequent notably as the first manifestation of the disease. Here we report the case of a 22-year-old woman presenting with cardiac tamponade as the initial presentation of SLE.

Non-coronary cardiac manifestations of systemic lupus erythematosus in adults: a comparative study.

Cardiac manifestations develop in the majority of patients with systemic lupus erythematosus (SLE) at some time during the course of their disease. This study was designed to assess cardiac abnormalities in patients with SLE by echocardiography and to compare the 2 groups of patients with and without cardiac manifestations. It was a transversal, descriptive study, conducted in the Internal Medicine Department at the Military Hospital of Tunis from January 2016 to June 2018. Eighty lupus patients, diagnosed on the basis of ACR (American college of rheumatology) criteria, were enrolled in the study and were evaluated by standard echocardiography with color Doppler. Out of 80 patients 42 (52%) had abnormal echocardiographic findings. Pericardial effusion was found in 55%, valvular abnormalities in 52% and 38% had pulmonary hypertension. Patients with pleural effusion (45 vs 15%) were more vulnerable to cardiac involvement as well as renal impairment (57 vs 44%). The difference, however, were not statistically significant (p>0.05) in the renal involvement. Active disease with low complement (80%) was associated with higher frequency of cardiac involvement than disease in remission (64%) but the result was not statistically significant (p=0.11). Cardiac abnormalities are very common in lupus patients even when clinically asymptomatic form. Echocardiography is an excellent non-invasive tool for cardiac evaluation. Their research must be systematic with echocardiography in order to reduce subsequent cardiac morbidity and mortality among the lupus patients.

Severe metastatic calcifications in a hemodialysis patient.

Tissue calcification is a common complication in patients on continuous hemodialysis (HD) for chronic renal failure; however, severe calcification is unusual. Three distinct clinical types of extraosseous calcifications are found in uremic patients: vascular calcification, periarticular (tumoral) calcification, and visceral calcification (heart, lung, and kidney). We report a case of a young chronic HD patient who presented with extensive metastatic calcifi cations both vascular, visceral specially localized in the lungs, and periarticular with progressively increasing multiple subcutaneous swellings. This evolution was secondary to noncompliance of the patient to the treatment of a malignant hyperparathyroidism with a marked elevation of phosphocalcium product.

[Dermatomyositis and Panniculitis: the function of immunoglobulins]. / Dermatomyosite et panniculite: place des immunoglobulines.

Panniculitis is an inflammatory disease of subcutaneous adipose tissue which is rarely associated with dermatomyositis. It can occur before, after or simultaneously with muscle damage. In most cases, the evolution of panniculitis and of other dermatomyositis affections is favorable with corticosteroids and/or immunosuppressants. We report the case of a 48 year-old patient who developed panniculitis lesions 2 months before having muscular signs. Skin involvement was resistant to corticosteroid treatment associated with immunosuppressants drugs. This led to the use of polyvalent immunoglobulin treatment improving both skin and muscle damage.

Coexistence of pyoderma gangrenosum and sweet's syndrome in a patient with ulcerative colitis.

Pyoderma gangrenosum (PG) and Sweet's Syndrome (SS) are inflammatory skin diseases caused by the accumulation of neutrophils in the skin and, rarely, in internal organs. These neutrophilic dermatosis (NDs) are distinguished by the existence of forms of transition or overlap. They are frequently associated to systemic diseases especially hematologic and gastrointestinal ones. We report a case of a patient with ulcerative colitis (UC) who successively developed two types of NDs: PG then SS. A 66 years old patient with a history of UC consulted in July 2012 for an erythematous swelling of the back of the right hand treated with antibiotics without improvement. At that time, bacteriological samples were negative. In October 2012, he was hospitalized for polyarthralgia and impaired general condition. In physical examination, he had vesiculobullous plaque of 10 cm long of the right hand and wrist, infiltrated erythematous plaque on the right leg and another topped with a large pustule at the left ankle. Skin biopsy showed at the back of the right hand an aspect of PG and at the infiltrated plaques of the ankle an aspect of SS. Prednisone was started with improvement of the skin lesions and a recovery condition. The combination of PG and SS has already been described in cases of hematologic malignancy and rarely in UC. There is also the notion of passage from a neutrophilic dermatosis to another. Indeed, a typical lesion initially of SS can evolve to a future PG. This case demonstrates that neutrophilic dermatoses form a continous spectrum of entities that may occur in UC.

Renovascular hypertension: a report of 21 cases.

Renovascular hypertension (RVH) is among the most common forms of secondary hypertension. We studied 21 patients (eight male and 13 female) with RVH who were encountered during a period of 16 years. The average age of the patients was 34.75 years. Trans-renal Doppler ultrasound confirmed the diagnosis of renovascular stenosis (RAS) as the cause of RVH in 95% of the patients. Computed tomography angiography was performed in ten cases, which confirmed the diagnosis in all these cases. Magnetic resonance angiography was performed in only three patients. Renal scintigraphy was performed in 11 patients, with DTPA in nine patients and with MAG3 in two cases. Arteriography was performed in 15 cases for therapeutic end points. In two patients, we treated the arteries of both kidneys and in 19 cases we treated only one kidney artery. Percutaneous transluminal angioplasty was performed in ten cases. Renal arterial stent placement was performed in three cases in which RAS was from an atherosclerosis etiology. Surgical revascularization was performed in four cases. Nephrectomy was necessary in four cases. After interventional treatment, medical treatment using antihypertensive drugs was necessary in 17 of the patients. After treatment, three patients returned to normal kidney function, while worsening of glomerular filtration rate was noted in four patients. Some complications such as a kidney infarct after treatment, a nephrectomy, artery thrombosis, an ischemic stroke and recurrent RAS were also noted.