First description of Mycobacterium tuberculosis and M. canettii concomitant infection: report of two cases.

We report the first two cases of tuberculous coinfection with Mycobacterium tuberculosis and M. canettii. Both patients were young Djiboutian females with pulmonary tuberculosis (TB). One had a miliary pattern with concomitant human immunodeficiency virus infection. Both recovered completely with a standard four-drug anti-tuberculosis treatment regimen. Due to the different natural reservoirs and routes of infection of these two strains, our study supports the common belief that multiple strains of infection in TB are related to superinfection rather than concomitant infection.

Hypereosinophilia and epigastralgia after visiting Tunisia: a rare differential diagnosis of helminthiases.

Causes of hypereosinophilia among travelers returning from North Africa are dominated by helminth infections, especially when associated with gastrointestinal signs. Non-infectious causes must nonetheless be investigated after negative microbiological assessment and failure of a broad empiric antiparasite treatment. We report the case of a young man with epigastralgia and major weight loss since a stay in Tunisia. Empiric treatment with albendazole was not successful. Eosinophilic gastroenteritis was diagnosed and resolved under corticosteroid treatment.

[Acute pericarditis and tamponade: An unusual revelation of a visceral tuberculosis]. / Péricardite aiguë et prétamponnade: un mode de révélation atypique d'une tuberculose viscérale.

Tuberculosis is a common pulmonary disease, which is still endemic in disadvantaged communities. Pericarditis is a rare but very lethal visceral localization. The authors report the case of a 58-year-old man, without neither medical history nor social risk, who presented a cardiac tamponade as the first and atypic manifestation of a visceral tuberculosis.

[Mycoplasma pneumoniae encephalitis successfully treated by levofloxacin]. / Méningo-encéphalite aiguë à Mycoplasma pneumoniae de l'adulte traitée avec succès par lévofloxacine.

INTRODUCTION: Mycoplasma pneumonia (MP) infection may be associated with several neurological complications. Encephalitis, which affects children and rarely young adults, is the most frequent. CASE REPORT: A 23-year-old man was admitted for pneumonia with encephalitis. Mycoplasma pneumoniae infection was documented by serology, and polymerase chain reaction in the cerebrospinal fluid. Despite serious initial presentation, outcome was favourable with levofloxacin treatment. CONCLUSION: MP infection should be considered as a potential aetiology in acute encephalitis in young people and in individuals with respiratory symptoms. Antibiotic therapy (fluoroquinolones or macrolides) should be used if MP is strongly suspected or in case of severe acute meningo-encephalitis.

Infectious diseases related aeromedical evacuation of French soldiers in a level 4 military treatment facility: a ten year retrospective analysis.

BACKGROUND: Infectious diseases are a frequent cause of morbidity in French troops deployed abroad. They are usually minor in severity and managed by field practitioners. We aimed to describe the etiological spectrum of travel-related infections in French soldiers evacuated to a level 4 military treatment facility. METHODS: We evaluated the diagnoses of all service members who were medically evacuated from abroad to our infectious diseases department from January 1, 2004 to October 30, 2013. RESULTS: One hundred and twenty five cases, median age 32 years were referred, 117 (94%) were male and 78 (62%) were from the Army. Main areas of deployment were Africa in 80 cases (64%), Afghanistan in 15 cases (12%), and French Guiana in 10 cases (8%). Median time between initial consultation and hospitalization in the reference center was 5 days (IQ 2-7 d). Thirty (24%) immediate aeromedical evacuations were carried out. The top five diagnoses were Plasmodium falciparum malaria (30), fever of unknown origin (15), cerebro-meningeal infections (10), invasive amebiasis (9), and HIV primary infections (9). Thirteen individuals were admitted in ICU. No death was recorded. CONCLUSIONS: Infectious diseases were a rare of cause of medevac. Most of them were preventable. Lethal etiologies were represented by malaria and cerebro-meningeal infections.

Aortic thrombus and multiple embolisms during a Mycoplasma pneumoniae infection.

We report the case of a patient who presented with a thrombus of the aortic arch complicated with splenic, renal and peroneal artery embolisms, associated with transient lupus anticoagulant, during a Mycoplasma pneumoniae infection. The outcome was good under antibiotic and anticoagulant treatment. We also review the medical literature on M. pneumoniae-related thromboses.

Management of a rifampicin-resistant meningococcal infection in a teenager.

We report a secondary case of rifampicin-resistant meningococcal disease and our experience in managing contact cases. Rifampicin resistance resulting from rpoB gene mutations is still uncommon enough that changing the current recommendations for chemoprophylaxis is unwarranted. However, ensuring limited but appropriate chemoprophylaxis may prevent the development of antimicrobial resistance. Thus, the definition of contact cases should be strictly respected. In the case of culture-positive Neisseria meningitidis, in vitro susceptibility testing to rifampicin must be systematically performed in order to detect rifampicin-resistant strains and, thus, institute appropriate prophylaxis in order to prevent secondary transmission.

Recurrent pyelonephritis due to NDM-1 metallo-beta-lactamase producing Pseudomonas aeruginosa in a patient returning from Serbia, France, 2012.

We describe the first isolation in France of a New-Delhi metallo-beta-lactamase-1 (NDM-1) producing Pseudomonas aeruginosa. In March 2012, a patient with history of prior hospitalisation in Serbia was diagnosed in France with acute pyelonephritis due to NDM-1 producing P. aeruginosa. Clinical and microbiological cure was obtained under appropriate antibiotic treatment. Two months later, she presented with a recurrence due to the same bacteria, with a favourable evolution. During both hospitalisations, contact isolation precautions were implemented and no cross-transmission was observed.

[Mycoplasma pneumoniae: a cause of febrile hemolytic anemia in travelers]. / Mycoplasma pneumoniae: une cause d'hémolyse fébrile chez le voyageur.

Mycoplasma pneumoniae can cause varied hematologic manifestations that are frequently associated with lower respiratory tract infections. Acute febrile hemolysis without respiratory symptoms is quite rare. We describe the case of a 25-year-old man, admitted for acute fever with hemolysis, after returning from Djibouti. M. pneumoniae infection was proved by serological testing. A favorable outcome followed macrolide treatment.

[An unusual paraneoplastic manifestation in lung cancer: eosinophilic erythroderma]. / Une manifestation paranéoplasique inhabituelle dans le cancer bronchique: l'érythrodermie hyperéosinophilique.

An 81-year-old man was admitted for generalized weakness, erythrodermia and eosinophilia. His chest CT showed nodules related to lung adenocarcinoma. Chemotherapy induced a tumour response with the disappearance of the erythrodermia and eosinophilia. A tumour relapse indicating the recurrence of the erythrodermia and eosinophilia was confirmed 2 months after completion of the chemotherapy. The outcome was rapidly fatal. The evolution of the symptoms suggests that eosinophilic erythrodermia is a paraneoplastic syndrome. Cutaneous paraneoplastic syndromes are rare but may be associated with lung cancer.

[Pulmonary involvement in the course of cytomegalovirus infection in an immunocompetent adult]. / Atteinte pulmonaire au cours d'une infection à Cytomegalovirus chez un adulte immunocompétent.

INTRODUCTION: Cytomegalovirus (CMV) infection in the immunocompetent is generally silent or it may present as a mononucleosis like syndrome but, rarely, it can lead to symptomatic manifestations. CASE REPORT: An immunocompetent and previously healthy 43- year-old woman presented with fever, dyspnoea, liver cell necrosis and a mononucleosis syndrome. The CT scan showed diffuse ground-glass opacity. BAL and blood cultures were sterile. Urinary antigens (Legionella pneumophila, Streptococcus pneumoniae) and serology for atypical respiratory pathogens (Mycoplasma pneumoniae and Chlamydia sp.) were negative. A diagnosis of CMV pneumonia was established on serology (presence of anti-CMV IgM) and PCR detection of viral DNA in the serum. Without antiviral therapy, there was a favourable clinical outcome 1 week later and 1 month later the CT scan was normal. CONCLUSION: CMV infection can lead, exceptionally. to a hypoxic pneumonia in the immunocompetent host. Antiviral therapy should not be prescribed systematically.

[Ulcerating haemorrhagic colitis induced by celecoxib]. / Colite aiguë ulcéro-hémorragique induite par le célécoxib.

INTRODUCTION: Selectivity of cyclooxygenase-2 inhibitors (Cox2 inhibitors) decreased gastroduodenal toxicity of nonsteroidal anti-inflammatory drugs. Effects on colic mucosa are little known. OBSERVATION: A case history is described of a 38-year-old women, without digestive past, who presented with hemorrhagic ulcerated acute colitis beginning 2 days after starting celecoxib (200 mg/d) prescribed for sciatica. DISCUSSION: Intrinsic imputability of celecoxib is very probable in this case report by combination of chronological and semiological criteria. Extrinsic imputability is discussed, starting from the available bibliographical data which relate primarily to rofecoxib. CONCLUSION: This observation, which constitutes, as far as we know, the first case report of hemorrhagic ulcerated colitis related to celecoxib, confirms the colic toxicity of anti-Cox2 and identify a new cause of acute colitis. Report of colic side effects with Cox2 inhibitors is required because of their new marketing.

[Common variable immunodeficiency with autoimmune manifestations: study of nine cases; interest of a peripheral B-cell compartment analysis in seven patients]. / Déficit immunitaire commun variable avec manifestations auto-immunes: étude de neuf observations; intérêt d'un immunophénotypage spécifique des lymphocytes B circulants chez sept patients.

PURPOSE: Autoimmune manifestations (AIM) are associated to common variable immunodeficiency (CVI) in about 20 to 25% of the cases. This study presents the clinical, biological characteristics and the evolution of nine patients developing CVI and AIM. A peripheral B-cell compartment analysis has been performed in seven cases. METHOD: This multicenter retrospective study analyses nine patients, six men and three women, within a population of 32 CVI. RESULTS: The mean age was 27 years at the time of diagnosis of AIM and 30 years at the time of diagnosis of CVI. The diagnosis of AIM preceded the diagnosis of CVI in five cases. Thirteen AIM of different types were observed: autoimmune hemolytic anemia (AHA, 3), immune thrombocytopenic purpura (ITP, 2), Evan's syndrome (2), primary biliary cirrhosis (1), rheumatoid arthritis (1), alopecia totalis (1), myasthenia gravis (1). The peripheral B-cell compartment was investigated in seven patients: five patients with autoimmune cytopenia presented with a diminution of memory B cells (CD27+IgD-) and immature B cells (CD21-) levels; the patient with primary biliary cirrhosis and myasthenia gravis had only a diminution of memory B cells level; the last patient with ITP presented with a normal level of memory B cells. Five among the seven patients with autoimmune cytopenia required a specific treatment using corticosteroids, high dosages of intravenous immunoglobulin, then splenectomy after failure of the medical management, with severe infectious complications in one case. CONCLUSION: The association of AIM and CVI is not fortuitous. The most common AIM is autoimmune cytopenia. The peripheral B-cell compartment analyses show that a majority of patients have a defect in memory B-cells. Treatment regimens are not standardized and splenectomy increases the risk of infectious complications.

[Recurrent acute idiopathic pancreatitis. Look for a chronic inflammatory disease of the intestine]. / Pancréatite aiguë récidivante idiopathique. Chercher une maladie intestinale chronique inflammatoire.

INTRODUCTION: Among the new identified causes of so-called idiopathic acute pancreatitis are chronic inflammatory diseases of the intestine. OBSERVATION: A 21 year-old man was hospitalised for the third episode of unexplained acute pancreatitis. Digestive endoscopies revealed an ulcerated terminal ileitis compatible with Crohn's disease. DISCUSSION: The frequency of idiopathic pancreatitis in patients exhibiting a chronic inflammatory disease of the intestine is of around 1%. Pancreatic involvement may precede the digestive manifestations of Crohn's disease and its clinical expression varies. An auto-immune mechanism appears to be responsible.