[Treatment by plasmapheresis of a thrombotic thrombocytopenic purpura associated to a Still's disease: a case report]. / Prise en charge par échanges plasmatiques d'un purpura thrombotique thrombocytopénique au cours d'une maladie de Still: à propos d'un cas.

We report the seventh published case of thrombotic thrombocytopenic purpura (TTP) associated to a Still's disease. We confirmed the secondary character of TTP using the measurement of ADAMTS 13 protease. Because of clinical and biological improvement, daily plasmapheresis was stopped after eight days of ICU treatment. Unfortunately, early (24 hours) relapse occurred resulting in daily plasmapheresis resumption for 11 more days. Main therapeutic goals and aggressive treatment duration of PTT associated with a Still's disease remain to be determined.

[Polyarthralgia disclosing hyperthyroidism. Two case reports]. / Polyarthralgies révélatrices d'hyperthyroïdie. Deux observations.

BACKGROUND: We report two cases of rheumatism associated with hyperthyroidism. In both cases, arthralgia totally regressed after thyroid treatment. CASE REPORTS: Two 79-year-old and 59-year-old women developed manifestations of polymyalgia rheumatica and psoriasis arthritis respectively. Corticosteroid therapy was ineffective and followed by manifestations of hyperthyroidism. The first patient was treated with carbimazole and the second with thyroidectomy. Once the hyperthyroidism was controlled, both patients experienced a dramatically rapid cure of their arthralgias. DISCUSSION: Scalpulo-humeral periarthritis is the main articular complication of hyperthyroidism. True manifestations of "thyrotoxicosis rheumatism" are unusual and may be linked with a direct toxicity of the thyroid hormones on joint cartilage or with an autoimmune manifestation of hyperthyroidism.

[Tubular necrosis after non-steroidal anti-inflammatory agents and acute alcoholic intoxication]. / Nécrose tubulaire après prise d'anti-inflammatoire non stéroïdien et intoxication éthylique aiguë.

Acute nephrotoxicity due to nonsteroidal anti-inflammatory drugs is usually observed in clinical situations in which renal perfusion is compromised as in volume contraction. We report a case of a 20 year-old woman who suffered from acute tubular necrosis after concomitant ingestion of nonsteroidal anti-inflammatory drugs and binge drinking. This acute tubular necrosis is likely to have an hemodynamic origin due to nonsteroidal anti-inflammatory drugs in a patient with volume contraction secondary to binge drinking. The risk appears to be even more important since ethanol has been implicated in tubular necrosis by direct toxicity. This observation underlines the danger in associating nonsteroidal anti-inflammatory drugs and ethanol.

[Bone marrow aplasia related to ticlopidine]. / Aplasie médullaire associée à la ticlopidine.

The authors report two cases of bone marrow aplasia observed 2 months after initiation of a treatment with ticlopidine. The outcome was favorable after discontinuation of therapy. The frequency of this severe drug-induced complication seems to have been underestimated. The absolute necessity of a careful haematological survey during the first 3 months of therapy is pointed out.

[Inflammatory rheumatism and celiac disease in adults. Coincidence or pathogenic relationship?]. / Rhumatisme inflammatoire et maladie coeliaque de l'adulte. Coïncidence ou lien pathogénique?

Five adults had inflammatory rheumatic disorders 6 to 20 years before the diagnosis of coeliac disease. It is known that joint inflammation occurs in certain patients with adult coeliac sprue who develop either a specific inflammatory rheumatic disease or an atypical progressive polyarthropathy, sometimes as the first manifestation of the intestinal disorder. The diagnosis of adult coeliac sprue should be entertained in these cases even in absence of major digestive disorders or malabsorption. IgA anti-reticulin antibodies and atrophy of the duodenojejunal villosities are the best indicators for diagnosis. There are two important reasons for making the diagnosis of "asymptomatic adult coeliac sprue". First a gluten-free diet can improve or even cure the inflammatory joint disease, a rare situation which emphasizes the causal relationship between these two diseases. Second, the risk of developing lymphoma (especially in the small bowel) is apparently lower in patients on gluten-free diet. Pathogenesis is unclear. Frequently the two autoimmune disorders simply appear to coincide in the same patient; more rarely, arthritis is a symptom of coeliac disease. The immunological mechanisms probably begin when antigens cross an excessively permeable intestinal mucosa.