Sarcoidosis with heart involvement: a rare association of terrible prognosis, a report of two cases.

Sarcoidosis is a multisystemic disorder of unknown etiology which is characterized by the formation of non-caseating granulomas in involved tissues. Cardiac involvement is one of the least common manifestations and it can occur at any point of time during the course of sarcoidosis. Here we present the case of 2 patients with known sarcoidosis who develop cardiac abnormalities in the absence of known primary cardiac cause. In our report, we would like to draw attention to the importance of considering heart involvement in any case with systemic sarcoidosis especially in young age.

Malaria in tunisian military personnel after returning from external operation.

Introduction. Malaria had been eliminated in Tunisia since 1979, but there are currently 40 to 50 imported cases annually. Soldiers are no exception as the incidence of imported malaria is increasing in Tunisian military personnel after returning from malaria-endemic area, often in Sub-Saharan Africa. Methods. We retrospectively analyzed the clinical and biological presentations, treatment, and outcomes of 37 Tunisian military personnel hospitalized at the Department of Internal Medicine, the Military Hospital of Tunis, between January 1993 and January 2011, for imported malaria. The clinical and laboratory features were obtained from the medical records and a questionnaire was filled by the patients about the compliance of malaria prophylaxis. Results. Thirty-seven male patients, with a mean age of 41 years, were treated for malaria infection. Twenty-two were due to Plasmodium falciparum. The outcome was favourable for all patients, despite two severe access. The long-term use of chemoprophylaxis has been adopted by only 21 (51%) of expatriate military for daily stresses. Moreover, poor adherence was found in 32 patients. Conclusion. The risk of acquiring malaria infection in Tunisian military personnel can largely be prevented by the regular use of chemoprophylactic drugs combined with protective measures against mosquito bites.

[Idiopathic portal hypertension associated with celiac disease: one case]. / Hypertension portale idiopathique associée à une maladie coeliaque: à propos d'un cas.

We describe for the first time a case of idiopathic portal hypertension (IPH) in a 31 year old patient with coeliac disease (CD). She had splenomegaly, pancytopenia and an unexplained portal hypertension in the absence of any histological abnormalities of the liver. The diagnosis of coeliac disease was based on histological and serological data. Treatment included a splenectomy and a splenorenal shunt.

[Neuro-psychiatric disorders revealed pernicious disease without anemia. About three cases]. / Tableau neuro-psychiatrique révélant une maladie de Biermer en l'absence d'anémie. A propos de 3 observations.

In addition to an anemic syndrome, pernicious disease can also include neuropsychiatric manifestations. We report here three cases diagnosed as pernicious disease revealed by neuropsychiatric symptoms and even without anemia. Our patients were made of a man and two women with a mean age of 55 years. They consulted for progressively worsening troubles of step which were related to a combined degeneration of the cord. This degeneration was associated to a cerebellar syndrome in one case. An isolated macrocytosis with a mean MGV at 109 fl, was noticed allowing thus to evoke the Biermer pernicious disease. This diagnosis was confirmed by the marrow puncture which showed a medullar megaloblastosis in two cases and an erythroblastic nucleocytoplasmic maturation's asynchronism. Treated by vitamin B12, the evolution was favorable in two cases with a total neurological recovery after six months in two patients. One patient died after six days of treatment following an acute myocardial infarction. If faced to symptoms made of a combined degeneration of the spinal card, a peripheral neuropathy and/or psychiatric troubles, pernicious disease is a diagnosis that we must evoke even in absence of anemia.

[Association of systemic lupus erythematosis and myasthenia gravis. A new case report]. / Association lupus érythémateux systémique et myasthénie. A propos d'une nouvelle observation.

The association of myasthenia gravis (MG) and systemic lupus erythematosus (SLE) is a quite rare one. We report here one case and try to discuss the physiopathologic mechanisms and also the clinical, evolutive and therapeutic features of this morbid association. It's the case of a woman of 43 years old followed in our department since 1999. The patient has been treated by corticosteroids (prednisone) with monthly administered cyclophospamide pulses. Nine months lately, she develops a diplopia with a ptosis, a dysphagia and a muscular weakness. The treatment was mainly based on intravenous immunoglobulins. The later evolution was favourable. The coexistence of SLE and MG is not casual. It must be considered in every lupic patient developing neuromuscular troubles.