Description of multiple myeloma cases and assessment of survival and mortality factors in Madagascar.

INTRODUCTION: In Madagascar, the epidemiologic, therapeutic, and evolutionary aspects of multiple myeloma remain poorly understood. Our objectives were to describe the cases, report factors associated with mortality, and estimate patient survival. PATIENTS AND METHOD: This was a retrospective descriptive and analytical study conducted in five teaching hospitals in Madagascar: HJRA and CENHOSOA (Antananarivo), CHUPZAGA (Mahajanga), CHUAT (Toamasina) and CHUT (Fianarantsoa). The study included patients diagnosed with multiple myeloma between January 1, 2010 and December 31, 2021. RESULTS: Of the 11,374 cancer patients, 75 (0.66%) had multiple myeloma. The mean age of the patients was 59.9 years (±8.9) and the sex ratio was 1.5. Arterial hypertension was observed in 32% of the patients. The most common symptom of myeloma was bone pain (n = 48; 64%). Forty-six patients (61%) were diagnosed with stage III myeloma and 28 patients (37.3%) with stage IIIA myeloma according to the Durie-Salmon classification. Anemia, renal failure, hypercalcemia and fractures were present in 53%, 37%, 21% and 28% of cases, respectively. Fifty-four patients received specific treatment. The combination of melphalan-prednisone-thalidomide was used in 79.63% of cases, and one patient had received autologous stem cell transplantation. Eleven patients (14.67%) died. Chronic kidney disease (p = 0.009), smoking (p = 0.028) and two associated comorbidities (p = 0.035) were associated with mortality. The median overall survival was 45.5 months. CONCLUSION: Patient survival is shorter than reported in the literature. The high mortality rate is due to comorbidities and limited access to recommended therapies.

Acute obstructive fungus ball pyelonephritis with Candida parapsilosis: A case report.

Key Clinical Message: Fungal lithiasis is a rare but serious complication of candiduria. Frequent use of broad-spectrum antibiotics is a contributing factor in predisposed subjects. Two CBEUs are required to confirm the diagnosis of candiduria. Anti-fungal is found effective to eradicate the fungus ball besides surgery. Abstract: Lithiasis by fungus ball is a serious complication of candiduria. Our case was a 58-year-old man who presented an acute obstructive pyelonephritis. Ultrasound revealed a left ureteral lithiasis. Biological examination revealed Candida parapsilosis. Antifungal was effective with good evolution. Broad-spectrum antibiotic therapy is one favoring factor.

Melanoma of unknown primary origin with skeletal muscle metastasis: a case report.

BACKGROUND: Melanoma is usually discovered from an irregular skin patch or a modification of a preexisting patch. Cutaneous and lymph node metastases are common. Muscle metastases are rare. We report a case of melanoma with infiltration of the gluteus maximus, which had normal dermatological examination. CASE PRESENTATION: A 43-year-old Malagasy man with no history of skin surgery was admitted with progressively worsening dyspnea. On admission, he presented with superior vena cava syndrome, painless cervical lymphadenopathy, and a painful swelling in the right buttock. Skin and mucous membrane examination did not reveal any abnormal or suspicious lesions. The biology was limited to a C-reactive protein of 40 mg/L, a white blood cell count of 23 G/L, and a lactate dehydrogenase level of 1705 U/L. The computed tomography scan showed several lymphadenopathies, compression of the superior vena cava, and a tissue mass at the expense of the gluteus maximus. Cervical lymph node biopsy and cytopuncture of the gluteus maximus were consistent with a secondary melanoma location. A stage IV melanoma of unknown primary origin, and with stage TxN3M1c associated with lymph node metastases and extension to the right gluteus maximus, was suggested. CONCLUSIONS: Melanoma of unknown primary origin accounts for 3% of diagnosed melanomas. Diagnosis is difficult in the absence of a skin lesion. Patients are diagnosed with multiple metastases. Muscle involvement is unusual and may suggest a benign pathology. In this context, biopsy remains essential for diagnosis.

Neuromeningeal cryptococcosis in a patient not infected with human immunodeficiency virus and without known risk factors: A case report.

We report a 24-year-old female patient not infected with human immunodeficiency virus (HIV) and without other risk factors of immunosuppression, presenting with neuromeningeal cryptococcosis. Cerebrospinal fluid (CSF) analysis revealed the presence of Cryptococcus neoformans. The evolution was unfavorable and the patient died even after appropriate antifungal treatment.

Spontaneous bilateral intraorbital hematoma: A particular form of sickle cell disease complications in children.

Spontaneous bilateral intraorbital hematoma is a rare complication of sickle cell disease in children. Imaging examinations are of paramount importance in the diagnosis and conditioning of the management processes in order to avoid complications that can compromise the visual function prognosis.

[Prevalence and etiological profiles of atypical localization venous thrombosis : A descriptive multicenter study]. / Prévalence et profils étiologiques des thromboses veineuses de localisation atypique : une étude multicentrique descriptive.

INTRODUCTION: Venous thrombosis of unusual sites is much rarer than in the lower limbs and requires a rigorous etiological approach. The objective was to describe the clinical and progressive peculiarities of unusual localization venous thrombosis as well as their etiologies. PATIENTS AND METHODS: Multicenter descriptive retrospective study of hospitalized patient records in the two large Hospital Centers, Antananarivo, Madagascar between 2017 and 2020 in which the diagnosis of unusual venous thrombosis was confirmed by imaging. RESULTS: Seventy-seven thrombosis of atypical localization were present in fifty-nine patients identified. These were 24 men and 35 women with an M/F sex ratio of 0.68. The mean age of our patients was 49.4 years (± 16.76). Thrombosis seated in the majority of cases in the portal veins (n ​​= 27), cerebral veins (n ​​= 20), vena cava (n = 10), splenic veins (n ​​= 5), upper limbs and splenomearic trunk (each n = 4), Renal vein (n = 3). Venous thrombosis had occurred following tobacco intoxication (n = 15 cases); bed rest (n = 10); surgical intervention (n = 4). The aetiological assessment revealed a neoplastic origin in 27 cases (45.77%) dominated by hepatocellular carcinoma (n = 13). the antiphospholipid antibody syndrome dominates the case of autoimmune causes (n = 4). In terms of mortality, there were no deaths during the initial hospitalization. Eight patients had died, 4 of them due to hepatocellular carcinoma, 2 after surgery, and 1 each due to kidney cancer and liver cirrhosis. The mean follow-up period was 34.03 ± 51.5 days. CONCLUSION: Unusual thrombosis, although rare, constitute a real challenge in the etiological approach. In clinical practice, the description of these thrombosis would allow us to understand their pathophysiological mechanism in order to plan the best management.

Pulmonary arteriovenous malformation revealing Osler-Weber-Rendu disease: A case report.

Osler-Weber-Rendu disease is a genetic disease characterized by mucocutaneous and visceral telangiectasias. Pulmonary arteriovenous malformation is one of the main visceral complications revealing Osler-Weber-Rendu disease. The present case was a 34-year-old woman with exertional dyspnea and severe hypoxemia revealing pulmonary arteriovenous malformations on chest CT scan.

Light chain Amyloidosis (AL) associated with multiple myeloma revealed by peripheral bilateral polyarthritis: a case report.

In chronic polyarthritis, the presence of macroglossia with absence of rheumatoid factor and anti-CCP antibodies may be suggestive of amyloid arthopathy. Clinical evaluation takes precedence over classification criteria.