[Thrombocytopenia purpura, myositis and cytolitic hepatitis: a rare association linked with atorvastatin]. / Purpura thrombopenique, myosite et hepatite cytolytique : une association rare d'incidents lies a l'atorvastatine.

Statins are generally well tolerated molecules. However, some cases have seen potentially lifethreatening consequences. We report a case of a 70-year-old woman with high blood pressure who was treating hypercholesterolemia by atorvastatin. Two weeks after beginning this new treatment, the patient developed muscular weakness in all four limbs with myalgias; and a purpura in the upper limbs and abdomen. A biological study revealed the presence of severe thrombocytopenia, myolysis and cytolytic hepatitis. Stopping the atorvastatin intake resulted in an improved situation within twenty days. This suggests that the medical anomalies found in the patient were drug-induced. The literature confirms the rarity of this association. The severity of some side effects of statins should remain in the minds of medicine prescribers.

Les statines sont des molécules généralement bien tolérées. Des accidents pouvant mettre en jeu le pronostic vital peuvent survenir avec leur utilisation. Nous rapportons l'observation d'une patiente de 70 ans hypertendue, chez qui l'on a découvert une hypercholestérolémie traitée par atorvastatine. Deux semaines après ce nouveau traitement sont apparus une faiblesse musculaire des quatre membres avec des myalgies; et un purpura aux membres supérieurs et à l'abdomen. La biologie révélait une thrombopénie sévère, une myolyse et une hépatite cytolytique. L'arrêt de l'atorvastatine a permis une évolution favorable en vingt jours. Cela suggère l'origine médicamenteuse des anomalies constatées. Les données de la littérature confirment la rareté de cette association. La gravité de certains effets secondaires des statines doivent rester à l'esprit des médecins prescripteurs.

[Thrombosis of the inferior vena cava and right atrium: a rare complication of an amebic liver abscess in Dakar, Senegal]. / Thrombose de la veine cave inférieure et de l'oreillette droite : complication rare d'un abcès amibien du foie à Dakar (Sénégal).

The liver is the most common site of extra-intestinal amebiasis. Amebic liver abscesses can be complicated by rupture, migration to adjacent organs or, more rarely, vascular thrombosis. The purpose of this report is to describe the case of a 52-year-old Senegalese man hospitalized for painful hepatomegaly associated with asymmetric bilateral pulmonary consolidation and fever. Abdominal ultrasound revealed a large abscess in the left lobe of the liver with a non-obstructive thrombus extending from the inferior vena cava to the right atrium. Doppler cardiac ultrasound depicted extensive right atrial thrombus formation. Chest radiography showed opacities in both lungs. Sputum smear tests for tuberculosis were negative, but amebic serology was positive. Treatment consisted of a combination of antibiotics (metronidazole/amoxicillin/clavulanic acid), curative heparin therapy, and abscess drainage. Complications during treatment included thrombosis of the right chambers of the heart and a suspected pulmonary embolism. Outcome was favorable and the thrombi disappeared. The available literature confirms the rarity of this complication, which can have severe consequences due to embolism.

[Unusual aspect of pernicious anemia during association of beta-thalassemia: a new case report and literature review]. / Maladie De Biermer De Presentation Inhabituelle Sur Un Profil Beta Thalassemique : Apport D'Un Nouveau Cas Et Revue De La Litterature.

Pernicious anemia appears classically by macrocytosis. We report a case of a late discovered Biermer disease, on a 42-year-old young black woman. The reason was an unusual aspect of this disease in a context of betathalassemia. The patient presented chronic anemia which evolved during about ten year. Biology showed a normocytosis and signs of hemolysis according to beta-thalassemia. This was confirmed by an electrophoresis showing 9.1 % of fraction F some haemoglobin. Since this date, the patient was treated by folic acid alone with periodic transfusions of red blood cell. She presented eight years after the beginning of her disease, neurological deterioration. Diagnosis of pernicious anemia was finally established up on histological gastritis, low level of the blood rate of vitamin B12, macrocytosis, and presence of intrinsic anti-factor and parietal anti-cells antibodies.

Acute renal failure in the postpartum due to calcified myoma: a case report.

BACKGROUND: It has been reported that delivery can be a cause of urine retention. This complication occurs especially in case which are associated with a pelvic mass like calcified uterine myoma. But this unusual aspect of myoma can make ultrasonographic traps. OBJECTIVE: To report an unusual case of calcified uterine myoma which was unnoticed during pregnancy and made so obstructive renal failure few days after the delivery. CASE REPORT: Seven days after delivery a Twenty-nine-year-old Senegalese woman was admitted at a private hospital for a slight alteration of consciousness(Glasgow Coma Scale at 12). Emergency check-up showed an acute obstructive renal failure. Biological investigations showed ascendancy of granulocytes, deterioration of renal function with creatinin in 78 mg / l and urea in 1.82 g/l. Ultrasonographic examination revealed bilateral dilatation of renal calyces and an interstitial calcified uterine myoma compressing the bladder. Management consisted on a urethral catheterization of bladder, correction of hydro-electrolytic troubles and antibiotherapy (ciprofloxacin).Global evolution leads to fast fully consciousness, with disappearance of biological and ultrasonographic disorders. CONCLUSION: Calcified myoma can look like cephalic pole during pregnancy. This unusual aspect can be sometimes source of acute obstructive renal failure requiring urinary drainage in emergency. Improvement of women's management during postpartum can prevent such complications.