[Contribution of cerebral magnetic resonance imaging to etiological investigation of uveitis]. / Place de l'imagerie par résonance magnétique cérébrale dans le bilan étiologique des uvéites.

PURPOSE: Uveitis is a disorder for which etiologic assessment procedures are still not codified. Clinical presentation is heterogenous, with poor correlation between symptoms and neurological involvement. The aim of our study was to assess the contribution of cerebral magnetic resonance imaging (MRI) in the management of uveitis. METHODS: Seventy-one patients, 26 men and 45 women, were included between January 1st, 2000 and March 31st, 2008, in two groups "contributory MRI" and "not contributory MRI" according to diagnostic contribution of MRI. Clinical characteristics of uveitis, inflammatory, immunological and infectious biological features, and cerebral MRI were analyzed. RESULTS: A diagnostics was established in 38 (53.5%) patients. Five patients with multiple sclerosis and one case of Behçet's disease were diagnosed using cerebral MRI. CONCLUSION: This study points out cerebral MRI contribution as a second-line examination for the etiological diagnosis of uveitis especially in case of suspicion of multiple sclerosis or Behçet's disease.

Typhoidal tularemia: 2 familial cases.

Eastern France was not known as a region endemic for tularemia until year 2006. We report on 2 cases of typhoidal tularemia in Eastern France, a 43-year-old hospitalized woman and her husband. Diagnosis was established after fever clearance on serodiagnosis criteria. The source of infection is unclear. As persons in the same family may likely be exposed to a common zoonotic source of infection, tularemia should be considered in the etiologies of familial fever epidemics.

[Anti-TNF-α in the treatment of uveitis in the Besançon Hospital]. / Utilisation des anti-TNF-α dans les uvéites au CHU de Besançon.

BACKGROUND: Noninfectious chronic uveitis is a difficult-to-treat situation in which corticosteroids, immunosuppressive agents, and more recently, anti-tumor necrosis factor (TNF)-α are used to prevent and/or reverse severe visual impairment. This single-center retrospective study was designed to assess the use (indications, efficacy, and side effects) of anti-TNF-α agents in noninfectious uveitis. PATIENTS AND METHODS: Eight patients were analyzed: three children (age, 7-15 years) and five adults (age, 27-44 years). Anti-TNF-α agents were etanercept (three patients), adalimumab (four patients), and infliximab (four patients). Diagnoses were Behçet's diseases (n=3), sarcoidosis (n=1), juvenile chronic arthritis (n=2), spondyloarthropathy (n=2), one of the latter two combined with Crohn disease. In all cases, anti-TNF-α therapies were prescribed because uveitis and/or associated disease were not under control. RESULTS: Adalimumab and infliximab were effective for all patients. One patient with infliximab needed to add corticosteroids and immunosuppressive agents because of relapse. Etanercept was stopped in all cases due to a lack of effectiveness or a change in indication. In all patients, anti-TNF-α agents improved uveitis and the underlying systemic disease. In children, their use improved quality of life by corticosteroid weaning. Prescriptions did not comply with regulations for three children, because of age limits (etanercept, one; adalimumab, two). No adverse event was recorded. CONCLUSION: In this short case series, anti-TNF-α agents were effective both on uveitis and the underlying systemic disease and were well tolerated in patients with noninfectious chronic uveitis.

[Pseudo-myasthenic myopathy in a woman with anorexia nervosa]. / Pseudomyasthénie grave chez une anorexique.

Skeletal myopathy, although foreseeable in severe malnutrition, has been rarely reported in patients with anorexia nervosa. We report a case of oculo-oropharyngeal myopathy mimicking myasthenia in a 42-year-old woman with an history of anorexia nervosa, completely reversible after refeeding with carbohydrate diet, mainly chocolate. Nutritional myopathies are not well known and therefore rarely looked for in patients with anorexia nervosa. Classical presentation is a myogenic syndrome with severe type 2 fibre atrophy and biochemical characteristics similar to Mac Ardle's disease. A clinical form mimicking myasthenia gravis has never been reported. Refeeding programme leads to total recovery within a few days.

[Disseminated molluscum contagiosum during topical treatment of atopic dermatitis with tacrolimus: efficacy of cidofovir]. / Molluscum contagiosum profus au cours d'une dermatite atopique traitée par tacrolimus: intérêt du cidofovir.

BACKGROUND: Tacrolimus applied locally is a non-steroid anti-inflammatory drug with proven efficacy in atopic dermatitis. Skin infections can occur, especially viral infections. CASE-REPORT: A 35-year-old male patient had been treated for extensive atopic dermatitis for several months with tacrolimus (Protopic). After six months of treatment, he presented a large eruption of molluscum contagiosum, in particular on the zones that had received a substantial amount of tacrolimus. The treatment was discontinued and application of a preparation containing cidofovir led to the patient's quick complete recovery, without recurrence in the ensuing months. DISCUSSION: Viral skin infections, in particular poxvirus infections, are prompted by topical immunosuppressant treatments such as tacrolimus, usually in dose-dependent fashion. Paradoxically, they provide protection against bacterial infections by restoring the integrity of the cutaneous barrier. Application of cidofovir successfully treated a severe form of molluscum contagiosum rapidly without any noticeable adverse effects. This confirms several observations about the efficacy and the good safety of this drug in the treatment of infections by DNA viruses. It provides an additional therapeutic prospect for immunodepressed patients who often present extensive and resistant forms of infections that are usually common.

[Hypercalcemia of double origin: association of multiple myeloma and ectopic parathyroidal adenoma]. / Une hypercalcémie d'origine double: association myélome et adénome parathyroïdien ectopique.

INTRODUCTION: Multiple myeloma and primary hyperparathyroidism are two causes of hypercalcemia. This association has already been described to be not casual, despite their link is still unknown. OBSERVATION: We describe a 68 years old woman, without notable background, was admitted for low back pain. Biology showed an IgG Kappa multiple myeloma (stade 3) and an hypercalcemia without renal failure. Hypercalcemia was difficult to control with bisphosphonate and calcitonin. At first, there was also an hypophosphoremia and a high parathormone level (287 pg/ml). Imaging showed spread myeloma impairment and a right paramediastinal tissular mass. Biopsy diagnosed an ectopic parathyroidal adenoma. DISCUSSION: Multiple myeloma and primary hyperparathyroidism can be associated. They are often revealed by an hypercalcemia difficult to control or refractory to the treatment. Hypophosphoremia can suggest the diagnosis of hyperparathyroidism. Both this observation and litterature (about twenty case reports) suggest that this double diagnosis should be systematicly evoked and explored by an assay of parathormone and a seric proteins electrophoresis in all hypercalcemia. CONCLUSION: Multiple myeloma and parathyroidal adenoma should be both explored in all hypercalcemia, because they can be associated.

[Medullar cancer of the thyroid associated with dermal mucinosis]. / Mucinose dermique faciale associée à un cancer médullaire de la thyroïde sporadique métastatique.

INTRODUCTION: Dermal mucinosis can be associated with numerous pathologies, in particular involving the thyroid, but has never been described in the case of a medullar cancer of the thyroid (MCT). CASE-REPORT: A 69-year-old man consulted for a facial erythrosis, which had been developing for a few weeks without any identified triggering factor. The skin biopsy showed dermal mucinosis and tests revealed a sporadic medullar cancer of the thyroid with secondary bone, ganglion and medullar localizations. DISCUSSION: The association between medullar cancer of the thyroid and dermal mucinosis has never been described. Several hypotheses may explain this: the thyroid pathology itself, whatever its nature, the capacity of the MCT to synthesize mucin and the medullar metastatic overgrowth.