[Gout]. / La maladie goutteuse.

Gout is a chronic disease due to the deposition of monosodium urate microcrystals in joints and tissues. Its incidence and prevalence are increasing worldwide in close relation with the epidemic of obesity and metabolic syndrome. Gout is related to chronic hyperuricemia that should be treated to ensure the reduction or even the disappearance of acute attacks ("gout flares") and to reduce the size and number of tophi. If arthritis of the first metatarsophalangeal joint is the most typical form, other joints may be affected, including the spine. Demonstration of urate microcrystals arthritis allows diagnosis of gout but, in the absence of possibility of performing joint puncture, imaging may be useful for providing complementary diagnostic elements. Appropriate care is essential to reduce the number of flares and the evolution towards gouty arthropathy but also in terms of public health in order to reduce costs related to this pathology.

[Stingray injury: A case in French Polynesia]. / Piqûre de raie pastenague : un cas en Polynésie française.

INTRODUCTION: Stingray injuries occur when people inadvertently step on these fish. Penetration of the barb results in puncture and/or laceration wounds and lesions related to the venom. PATIENTS AND METHODS: We report the case of a 76-year-old woman in French Polynesia who was stung on her right ankle by a stingray. She initially had a hypertensive episode with encephalopathy and a haemorrhagic wound due to an indwelling fragment of the barb. Necrosis due to the poison required medical-surgical management with debridement, which yielded a favourable outcome. DISCUSSION: Stingray injuries are rare and not well-known by doctors. They can be serious due to injury by the barb and to venom poisoning, leading to enzymatic tissue destruction, ischaemia and intense pain. The initial treatment consists in immersion in hot water, as the venom is thermolabile; antibiotics and surgery may be necessary, depending on the condition of the wound.

[Zika fever]. / La fièvre zika.

Zika virus infection is an emerging arboviral disease which presented as a mild flu-like or algo-eruptive syndrome with fever, arthralgia, myalgia and a maculopapulous eruption. Severe neurological and fetal complications have recently been highlighted. Diagnosis is established by detection of viral RNA by Reverse Transcriptase-Polymerase Chain Reaction (RT-PCR). Many publications report on the progress of knowledge on zika and its complications. Treatment is symptomatic, mainly with analgesics. Prevention is essential through individual and collective vector control. Faced with this emerging arbovirus, health authorities of many countries have implemented significant resources to accelerate research efforts including on diagnostic tests and on the development of vaccines. In Europe, the presence of Aedes albopictus, a mosquito vector of the virus zika, runs the risk of autochthonous cases as well as autochthonous dengue or chikungunya fever. Hence, autochthonous zika fever is not excluded to appear during the warmest months in metropolitan French departments colonized by A. albopictus.

Decreased neonatal pain response after vaginal-operative delivery with Kiwi OmniCup versus metal ventouse.

BACKGROUND: Vaginal delivery, especially operative assisted vaginal delivery, seems to be a major stressor for the neonate. The objective of this study was to evaluate the stress response after metal cup versus Kiwi Omnicup® ventouse delivery. METHODS: The study was a secondary observational analysis of data from a former prospective randomised placebo controlled multicentre study on the analgesic effect of acetaminophen in neonates after operative vaginal delivery and took place at three Swiss tertiary hospitals. Healthy pregnant women ≥35 weeks of gestation with an estimated fetal birth weight above 2000 g were recruited after admission to the labour ward. Pain reaction was analysed by pain expression score EDIN scale (Échelle Douleur Inconfort Nouveau-Né, neonatal pain and discomfort scale) directly after delivery. For measurement of the biochemical stress response, salivary cortisol as well as the Bernese Pain Scale of Newborns (BPSN) were evaluated before and after an acute pain stimulus (the standard heel prick for metabolic testing (Guthrie test)) at 48-72 h. RESULTS: Infants born by vaginal operative delivery displayed a lower pain response after plastic cup than metal cup ventouse delivery (p < 0.001), but the pain response was generally lower than expected and they recovered fully within 72 h. CONCLUSIONS: Neonatal pain response is slightly reduced after use of Kiwi OmniCup® versus metal cup ventouse. TRIAL REGISTRATION: Trial was registered under under NCT00488540 on 19th June 2007.

[Severe cutaneous drug reactions to misused griseofulvin: 2 cases]. / Deux cas de toxidermies graves secondaires à un mésusage de la griséofulvine.

BACKGROUND: Griseofulvin is an antifungal drug known to cause drug rash. However, it is widely prescribed outside its classic indications. Herein, we describe 2 cases in which griseofulvin was prescribed for off-label indications. PATIENTS AND METHODS: Case No. 1. A 51-year-old woman was referred to the department of internal medicine for management of Stevens-Johnson Syndrome (SJS). The symptoms appeared 17 days after she had taken griseofulvin for inguinal intertrigo. Case No. 2. A 19-year-old female patient consulted for toxic epidermal necrolysis (TEN) affecting 30% of her body surface, with a positive Nikolsky sign and severe mucosal lesions. These symptoms appeared 9 days after she began taking griseofulvin, which had initially been prescribed for her husband for mycosis. DISCUSSION: Toxic epidermal necrolysis, a condition chiefly of drug-related origin, is a severe mucocutaneous syndrome characterized by massive keratinocytic apoptosis. Although there are few scientific publications referring to griseofulvin-induced drug eruption, they deserve to be mentioned since this drug is widely used for purposes other than the approved indications and can cause life-threatening reactions. CONCLUSION: We report two cases of toxic epidermal necrolysis related to the misuse of griseofulvin. It is important to bear in mind the precautions for use of oral antifungal drugs, which are strictly reserved for use against resistant or diffuse forms of mucocutaneous fungal infections.

[Transient global amnesia: A descriptive study of 12 Polynesian patients]. / Ictus amnésique: étude descriptive de 12 patients polynésiens.

INTRODUCTION: According to the criteria of Hodges and Warlow, transient global amnesia is defined by sudden onset of isolated anterograde amnesia of spontaneous resolution within one to twenty-four hours. Its pathophysiological mechanisms are still uncertain. METHODS: In a retrospective study, we have analyzed epidemiological, clinical and MRI data from twelve patients admitted to the only neurological department of French Polynesia for transient global amnesia corresponding to the criteria of Hodges and Warlow between January 2010 and December 2013. RESULTS: The median age of the cohort was 61.5 (53-72), the sex ratio was 1. Ten patients had one or more cardiovascular risk factors, 3 had migraine headaches and 3 had anxiodepressive disorders. Among triggers found, the occurrence during the rest was noted in one case. Retrograde amnesia was observed in 42% of cases, repetitive questioning in 75% of cases, anxious bewilderment in 67% of cases and disorientation in 33% of cases. The median episode duration was 9 hours and the duration of hospitalization was 3 days. Three patients had a recurrence. MRI was abnormal in all patients and showed diffusion-weighted hyperintensities in right (n=8), left (n=3) and bilateral (n=1) hippocampi. CONCLUSION: Epidemiological, clinical and MRI data from our cohort are similar to those from the literature except for the highest prevalence of cardiovascular risk factors and the most frequent right hippocampus involvement. Transient global amnesia occurring exceptionally while sleeping was also observed in one of our patients.

Zika virus infection complicated by Guillain-Barre syndrome--case report, French Polynesia, December 2013.

Zika fever, considered as an emerging disease of arboviral origin, because of its expanding geographic area, is known as a benign infection usually presenting as an influenza-like illness with cutaneous rash. So far, Zika virus infection has never led to hospitalisation. We describe the first case of Guillain-Barré syndrome (GBS) occurring immediately after a Zika virus infection, during the current Zika and type 1 and 3 dengue fever co-epidemics in French Polynesia.

[Myopericarditis as the presenting manifestation of adult Still's disease]. / Maladie de Still de l'adulte révélée par une myopéricardite.

INTRODUCTION: Adult Still's disease may present with multiple non-specific clinical manifestations leading to diagnostic difficulties. Presentation as initial myopericarditis is rare but must be known. CASE REPORT: We report a 49-year-old man who presented with the sudden onset of a high fever, arthralgia and myalgia, skin rash, dyspnea and chest pain related to a myopericarditis. Infectious, neoplastic and autoimmune diagnostic work-up was non-contributive. Adult Still's disease was discussed and confirmed by the decrease in the glycosylated fraction of ferritin. Corticosteroids followed by interleukin-1 receptor antagonist (anakinra) therapy allowed a rapid improvement in clinical and biological manifestations. CONCLUSION: Adult Still's disease should be considered in any systemic inflammatory disease without a diagnosis, even with atypical manifestations, especially since it can be life-threatening in the absence of treatment.

[Eosinophilic meningitis]. / Méningite à éosinophiles.

INTRODUCTION: Diagnosis of Angiostrongylus cantonensis meningitis is not always obvious, even in endemic areas. CASE REPORT: We report a 51-year-old Polynesian man, farmer without past medical history, who was admitted for mild fever, headache, neurological subjective symptoms, and severe muscle pain impeding walking. The diagnosis of A. cantonensis meningitis, guided by hypereosinophilia was confirmed by lumbar puncture and positive specific serology. Lumbar puncture and administration of corticosteroids rapidly reduced headache whereas paraesthesias declined more progressively. CONCLUSION: Diagnosis of A. cantonensis meningitis should be considered in patients living or returning from endemic areas with headache associated with subjective neurological symptoms and hypereosinophilia.

[Macrophage activation syndrome as the presenting manifestation of intravascular lymphoma]. / Lymphome intravasculaire révélé par un syndrome d'activation macrophagique.

INTRODUCTION: Intravascular large B cell lymphoma is a neoplastic cell proliferation leading to the occlusion of the lumen of small vessels. This is a rare haematological malignancy, which is difficult to diagnose because of a heterogeneous clinical presentation. CASE REPORT: We report a 62-year-old man who presented a macrophage activation syndrome as the presenting manifestation of an intravascular lymphoma. This association is frequently marked by a greater severity and clinical care requires an early and appropriate treatment. CONCLUSION: Due to the polymorphism and the systemic presentation of intravascular large B cell lymphoma, the internist may be confronted with this disease, which is considered to be more severe if associated with a macrophage activation syndrome. Awareness of the intravascular large B cell lymphoma is important because the prognosis depends on the rapidity of the initiation of chemotherapy associated with rituximab.

[Guillain-Barré syndrome following type 4 dengue in Polynesia]. / Syndrome de Guillain-Barré compliquant une dengue de type 4 en polynésie.

Dengue fever is the most frequent arbrovirus infection in the world. It is endemic in French Polynesia where epidemic outbreaks sometimes occur. The most common clinical presentation is that of a flu-like illness but hemorrhagic dengue fever can be observed in severe cases. Association of dengue fever with Guillain-Barré syndrome (GBS) has been reported in a few cases. The relationship between these two pathologies is unclear but autoimmune mechanisms are probably involved.