[Splenic marginal zone lymphoma and autoimmunity: report of six cases]. / Lymphomes spléniques de la zone marginale et auto-immunité: à propos de six cas.

INTRODUCTION: Autoimmune manifestations are common in splenic marginal zone lymphoma (SMZL) and are sometimes the presenting feature of the disease. Autoimmune cytopenia (anemia, thrombocytopenia) are the most frequently reported autoimmune conditions. However, other immunological manifestations may be associated with SMZL. METHODS: We report a retrospective case series of six patients with SMZL associated with autoimmunity. RESULTS: Auto-immune manifestations were the presenting feature of lymphoma in four cases. Auto-immune manifestations included auto-immune cytopenia in three cases (two hemolytic anemia and one pancytopenia), thyroiditis in two cases, systemic lupus and Still's disease in one case each. Antinuclear antibodies were detected with a titre of 1/250 in three cases, and with a titre of 1/32,000 in the patient with systemic lupus. Testing for DNA antibodies was negative in all cases. Two patients had a circulating lupus anticoagulant, with portal venous thrombosis following splenectomy in one case. One patient had hypogammaglobulinemia. A monoclonal gammopathy was detected in three patients. All patients had spleen enlargement. Immunophenotyping of blood peripheral lymphocyte was typical in five out of the six cases. Bone marrow was infiltrated in five out of the six cases. Diagnosis was obtained by the combination of immunophenotyping and bone marrow histopathology in five cases, and by splenic histopathology in the remaining case. Hepatitis C virus serology was negative in all patient. CONCLUSION: Autoimmune disease as systemic lupus or Still's disease may be associated with SMZL before its tumoral manifestations are evident. In this mode of presentation, spleen enlargement, hypogammaglobulinemia, monoclonal gammopathy, and multiple autoimmune diseases, should alert the physician.

[Nephrotic syndrome: don't forget to search for hypothyroidism]. / Syndrome néphrotique: penser à rechercher une hypothyroïdie associée.

INTRODUCTION: If abnormal thyroid function indices have been reported in patients with nephrotic syndrome, hypothyroidism is exceptional. EXEGESIS: We report three adult patients (1, 2, 3) with hypothyroidism associated with nephrotic syndrome (minimal change glomerulonephritis [1], idiopathic membranous nephropathy stage I [2], stage II [3]). Glomerulopathy treatment and thyroid hormone replacement therapy were both initiated. Low replacement (1, 2) was sufficient when proteinuria decreased. It was higher when nephrotic syndrome was uncontrolled (3). CONCLUSION: Excessive thyroxine-binding protein and thyroxine urinary loss generate low rate of free thyroxine and elevated TSH. Systematic thyroid hormonal test is necessary if nephrotic syndrome is severe and prolonged.

[Nitrofurantoin-induced lung disease: about two cases]. / Pneumopathie à la nitrofurantoïne: à propos de deux observations.

INTRODUCTION: Nitrofurantoin is commonly used in the treatment of urinary tract infection and may cause a potential severe complication: interstitial lung diseases. CASE REPORT: A 78-year-old and an 87-year-old woman treated with nitrofurantoin since respectively 10 months and 6 years developed cough and dyspnea. Antibiotics were ineffective and interstitial lung disease was found. Nitrofurantoin's stopping allowed a clinical and radiological improvement. CONCLUSION: A good medical supervision is important when nitrofurantoin is prescribed for a long time. The treatment has to be stopped when respiratory symptoms appear to allow an improvement of the symptoms.

[Lingual tuberculosis revealing disseminated tuberculosis]. / Tuberculose disséminée révélée par une localisation linguale.

INTRODUCTION: Tuberculous lesions of the oral cavity are uncommon. Most of cases are secondary to pulmonary disease and the primary form is rare. EXEGESIS: We report the case of a 64 year-old man, smoker, presenting a chronic ulcer of the tongue, with anorexia and important weight loss. The biopsy of this ulcer showed granulomatous inflammation and Langhans type giant cells, without necrosis. Ziehl-Nielsen stain was negative. Pulmonary lesions were subsequently detected (chest X-ray, CT-scan) and the disseminated tuberculosis was confirmed by a positive culture with acid-fast bacilli in urine, blood, and pulmonary sample. Antituberculosis treatment resulted in the complete resolution of the oral lesion. CONCLUSION: Biopsy for histopathological diagnosis, acid-fast stains and culture, is essential to determine the exact nature of chronic oral ulceration to distinguish between oral malignancy, infectious (syphilis), traumatic, or aphthous ulcers. Tuberculosis of the tongue is a difficult diagnosis. However it should be searched for because treatment usually results in a rapid recovery.