Myocarditis associated with campylobacter jejuni colitis: a case report.

Myocarditis is a rare complication of acute diarrhea due to Campylobacter Jejuni infection. We present the case of 25-year-old male who presented with campylobacter jejuni colitis who subsequently had chest pain and elevated cardiac biomarkers. The patient developed acute myocarditis confirmed on cardiac magnetic resonance imaging.

Adult Hemophagocytic Lymphohistiocytosis in Sub-Saharan Area: A Retrospective Study of 26 cases.

Introduction and background Hemophagocytic lymphohistiocytosis (HLH) is a condition caused by inappropriate stimulation of macrophage cells with hemophagocytosis. This paper aims to describe its diagnostic specifics and etiology and seeks to identify the factors that affect its prognosis in the black African adult population. Methods  A retrospective multicentre study was carried out in three medical units in Senegal: Department of Internal Medicine at Pikine Teaching Hospital, and Department of Internal Medicine and Department of Nephrology at Aristide Le Dantec Teaching Hospital; the study covered the period from January 1, 2012 to March 30, 2015. This study included patients aged 18 years and older with a Hemophagocytosis Score (HScore) of ≥202 (with probabilities of acquired HLH of >90%). The data was obtained through medical records. Results In total, 26 patient files were included. The average age of the patients was 41 years, with a male-to-female ratio of 2.25:1. Fever and cytopenia were frequent. Other clinical signs included peripheral lymphadenopathy (69.2%), hepatomegaly (53.8%), splenomegaly (34.6%), neurological disorders (34.5%), and respiratory disorders (15.3%). Thrombocytosis was noted in three cases. Renal involvement was present in eight patients, with one case of collapsing glomerulopathy. The bone marrow aspirate revealed myelodysplasia in 12 patients. The dominant etiologies of HLH were hematological malignancies and infections. The mortality rate of HLH was 73%. Male gender and non-etiological targeted therapy were significantly associated with mortality. However, the age of <40 years in patients and current systemic disease in some cases were correlated with survival. The use of etoposide had no significant impact on the prognosis of our patients. Conclusion A high rate of male predominance, important central nervous system disorders, myelodysplasia, and paradoxical thrombocytosis were found to be the distinct features of adult HLH in our study population.

[Thyrotoxic hypokalemic periodic paralysis in two African black women]. / Paralysie périodique hypokaliémique thyrotoxique chez deux femmes noires africaines.

Thyrotoxic hypokalemic periodic paralysis is a rare complication of hyperthyroidism. It has been most often reported in Asian subjects while it has been little described in the black population. Its mechanism has been little elucidated, but it would be caused by hyperactivity of the Na+/K+pump. We here report two cases of thyrotoxic hypokalemic periodic paralysis in black African subjects. The clinical manifestation was identical in both patients: proximal muscle paralysis of the lower limbs. Paralysis was associated with severe hypokalemia and occurred in female patients treated for Graves' disease without any other associated disease. Outcome was immediately favorable under potassium supplementation. Treatment of hyperthyroidism prevented recurrences. This study highlights the importance of suspecting the diagnosis of thyrotoxic hypokalemic periodic paralysis despite its rarity in the black African population.

The Parathyroid carcinoma: a diagnostic challenge before surgery.

INTRODUCTION: Parathroid Carcinoma is a rare cause of primary hyperparathyroidism (PPH). His diagnosis is a real challenge. We report an observation and discuss the diagnostic guidelines before surgery. CASE: A 31-year-old Senegalese woman was admitted to our department for the exploration of diffuse bone pain and multiple pathological fractures. Physical examination revealed a right lateral mass of the neck. Serum calcium level was 142.2 mg / l and serum parathyroid hormone 42 N. Ultrasound and cervical tomodensitometry showed a parathyroid mass compressing the thyroid and trachea. The extension assessment revealed osteolytic lesions and T4-T5 epiduritis evoking metastases. Surgery and histology were performed. According to the histopathology and clinical context, the tumor was identified as a parathyroid carcinoma. CONCLUSION: The preoperative evaluation of a patient with severe hypercalcemia and high PTH levels should include the possible diagnosis of parathyroid carcinoma, especially in symptomatic patients or in case of palpable neck mass.

[Pseudotumoral tuberculosis of the cervix]. / Tuberculose pseudo tumorale du col de l'utérus.

Tuberculosis of the cervix is rare and can mimick cervical cancer. Patients are paucisymptomatic and the disease is characterized by an insidious evolution, hence the delay in diagnosis. Common symptoms are non-specific contributing to therapeutic delay and increasing the risk of infertility which is perhaps inevitable. We report a case of tuberculosis of the cervix whose diagnosis given first wasn't obvious. Indeed, a patient was referred to our Department with suspected cervical cancer. Suspected diagnosis of cancer was then retained based on the presence of vaginal bleeding on contact and abdominopelvic CT scan results showing cervical cancer. Biopsy was indicated in order to confirm the diagnosis histologically. Anatomo-pathological examination objectified epitheliogigantocellular granuloma with caseous necrosis, supporting cervical tuberculosis. The other examinations were negative. The patient received TB treatment which led to healing. Diagnosis and treatment of tuberculosis of the cervix is often based on presumptive elements, hence the importance of anatomo-pathological examination.

[An unusual cause of jaundice]. / Une cause inhabituelle d'ictère.

Hepatic impairment is common during hyperthyroidism. It is most often asymptomatic. Hyperthyroidism revealed by jaundice has been rarely described in the literature. We here report the case of a 52-year old patient in Dakar (Senegal) presenting with jaundice associated with pruritus. Laboratory tests showed elevated alanine aminotransferases (1.1 N), aspartate aminotransferase(1.5 N), alkaline phosphatases (3 N), gamma glutamyl transferases (1.3 N) and bilirubinemia (22 N). Abdominal ultrasound was normal. A toxic or drug-related cause, bile duct obstruction, viral or autoimmune hepatitis as well as primary biliary cholangitis were excluded. The dosage of thyroid hormones showed elevated free T4, 24 ng/dL (9-20 ng/dL) and undetectable plasma TSH less than 0.01µUI/mL (0,35-4,94 IU/mL). TSH receptor antibodies were positive 7.04 IU/L (n < 1.75 IU/L). Thyroid ultrasound objectified diffuse homogeneous hypervascular goiter. The diagnosis of hepatic impairment secondary to Graves-Basedow disease without cardiac dysfunction was retained. Clinical outcome and laboratory test results were favorable under carbimazole. Jaundice can be an indicator of hyperthyroidism. An investivation of clinical signs and laboratory parameters for hyperthyroidism is essential in patients with unexplained jaundice.

[Diagnostic and evolutionary profile of multiple myeloma in Senegal: monocentric study conducted from 2005 to 2016]. / Profil diagnostique et évolutif du myélome multiple au Sénégal: étude monocentrique de 2005 à 2016.

INTRODUCTION: Accessibility to innovative multiple myeloma therapies is limited in sub-Saharan Africa. This study aimed to describe the diagnostic and evolutionary features observed during treatment of our patients with myeloma. METHODS: We conducted a retrospective, descriptive, analytical study (2005 - 2016) of patients with myeloma included in the study based on International Myeloma Working Group (IMWG) Criteria (2003,2014) at the Hopital Aristide Le Dantec (Senegal). RESULTS: We collected data from 136 medical records (69 men, 67 women) of patients with an average age of 59 years ± 10.1 years, who were less than 65 years of age in 69.1% of cases. Tell-tale signs included bone pain (96.3%), renal failure (36.8%), infection (23.5%), pathological fracture (17.6%), spinal cord compression (16.9%) and malignant hypercalcaemia (16.2%). Isotopic antiglobulin test showed that anti-IgG could be detected in 61.3% of cases and Kappa in 65% of cases. Patients were classified stage III (59.4%) and I-II (40.6%)of the index staging system. The median survival of patients under conventional traitement (Méphalan-Prédnisone: 67.6%, innovative: 5.9%) was 20 months (1-78 months). Survival rates are better in the absence of neurological and infectious complications and for patients with score I-II of the index Staging System. CONCLUSION: In our study, multiple myeloma was frequently diagnosed before age 65, at advanced stage of tumor mass. Early detection and access to adequate therapies could improve overall survival.

Tuberculosis arthritis of the sternoclavicular joint after uncomplicated falciparum malaria: a case report.

BACKGROUND: Malaria and tuberculosis are co-endemic in many developing countries. However their associations are rarely reported. Yet, it has been suggested that a pathological process may link the two diseases. CASE PRESENTATION: A 20-year-old female patient was admitted in the internal medicine service of Aristide Le Dantec Hospital for uncomplicated malaria. She was previously treated for autoimmune hemolytic anaemia using prednisone at 5 mg per day. Clinical examination showed swelling in front of the sternoclavicular joint. She presented with fever and headache. Thick smear from blood revealed trophozoites of P. falciparum at parasite density of 52,300 parasites/µl. The Ziehl-Neelsen stained smear showed the presence of acid-fast bacilli from the fluid puncture of the swelling. Mycobacterium tuberculosis was further isolated in culture. The diagnosis of falciparum malaria co-infection with sternoclavicular tuberculosis was posed. The patient was treated successfully using antimalarial drugs subsequently followed by multidrug antitubercular therapy. CONCLUSION: Interactions between malaria and tuberculosis need to be largely and prospectively investigated and appropriate treatment should be undertaken.

[Epidemiological, clinical, therapeutic and evolutive aspects of Basedow-Graves disease in the Depatment of Internal Medicine at CHU Aristide Le Dantec, Dakar (Senegal)]. / Aspects épidémiologique, clinique, thérapeutique et évolutif de la maladie de Basedow en Médecine Interne au CHU Ledantec Dakar (Sénégal).

Basedow-Graves disease is an autoimmune affection characterized by the association of thyrotoxicosis with variable frequency events such as goiter, ophthalmopathy and pretibial myxedema. Its diagnosis is often easy, while its management remains difficult. A simple medical treatment exposes patient to recurrence risk. In Senegal and Sub-Saharan Africa few studies have focused on Basedow-Graves disease. This study aims to describe the epidemiological, clinical, therapeutic and evolutionary aspects of Basedow-Graves disease at a Hospital in Dakar. This was a retrospective study conducted from 1 January 2010 to 31 December 2013 in the Department of Internal Medicine at the Aristide Le Dantec University Hospital. During this period, 108 patients receiving outpatient treatment for Basedow-Graves disease were included out of a total of 834 patients receiving outpatient treatment. The diagnosis was made on the basis of clinical, biological and immunological signs. One hundred and eight patients suffering from Basedow-Graves disease were included out of a total of 834 consultations. Sex ratio was 7.3 and the average age was 34.6 years. The main reasons for consultation were: palpitations and weight loss in 46.3% and 39.8% of cases respectively. Thyrotoxicosis syndrome was found in 93.5% of patients, goiter was found in 87% of patients and exophthalmos in 78.7% of patients. The main complication was cardiothyreosis found in 11.1% of patients. All patients underwent antithyroid synthetic drugs treatment. The evolution was favorable in 19,4% of cases. Disease recurrence was observed in 57% of cases and in 23.1% of patients were lost to follow-up. Basedow-Graves disease is the most common cause of hyperthyroidism, The patient's clinical picture is dominated by manifestations related to hypermetabolism. This study highlights that thyroidectomy isn't the first-line of treatment if we consider the high number of recurrences after medical treatment.