Interstitial Cystitis: An uncommon revelation in primitive Sjögren syndrome.

Interstitial cystitis is an exceptional entity during primary Sjögren's syndrome. In this regard, we report the case of a 67-year-old patient in whom initially idiopathic interstitial cystitis revealed primary Sjögren's syndrome after 5 years of evolution in front of xerostomiaa, xerophtalmia and bilateral parotid hypertrophy with histological confirmation at the biopsy of accessory salivary glands.

Three scenarios of nasal obstruction revealing sarcoidosis.

The nasal location of sarcoidosis is rare. In this regard, we report three observations of sarcoidosis observed in three women with an average age of 53.6 years, revealed by annoying nasal manifestations. The presence of extra-nasal sites allowed us to suspect the diagnosis of sarcoidosis in all the patients.

[Characteristics of deep vein thrombosis in the elderly]. / Particularités de la thrombose veineuse profonde chez le sujet âgé.

PURPOSE OF THE STUDY: Deep vein thrombosis is a common condition in geriatric. The identification of risk factors for venous thrombosis in the elderly is important because it allows an appropriate prescription of preventive treatments. The purpose of this study is to identify the etiologic and therapeutic characteristics of deep vein thrombosis of the lower limbs in the elderly. PATIENTS AND METHODS: A retrospective study of 155 patients with lower limb deep vein thrombosis confirmed by venous Doppler. These patients were divided into two groups: group 1 (patients aged 65 years or more) and group 2 (patients whose age was below 65 years). A comparison between these two groups was performed. RESULTS: The average age of patients in group 1 was 74.89 years (± 6.43). The sex ratio in this group was 0.68. The thrombosis was more frequently proximal in patients of group 1. Patients of group 1 had significantly more risk factors than those of group 2 (p <0.05). Among risk factors studied, only the cancers were significantly more frequent in group 1 (p = 0.002). The frequency of hemorrhagic events in both groups was comparable but bleeding was more common in patients of group 1 with cancer. CONCLUSION: Our study confirms the multifactorial origin of deep vein thrombosis in the elderly and the incidence of malignant etiology. The results of this study also call for vigilance in the use of anticoagulants in the elderly especially in the presence of cancer because it is an additional risk factor for bleeding.

[Syndrome d'activation macrophagique: une série de 11 cas tunisiens]. / Hemophagocytic syndrome: a study of 11 patients in tunisian population.

BACKGROUND: Hemophagocytic syndromes are mostly associated with underlying pathology, they can reveal: immunodeficiency, infections, hemopathies, cancers and auto-immune diseases. AIM: to investigate clinical, biological features, outcome characteristics and underlying pathology of Tunisian patients with hemophagocytic syndromes. METHODS: A retrospective study of patients with hemophagocytic syndromes admitted in an internal medicine department in Tunis over the period 2009-2012. RESULTS: There were 11 patients included, 4 men and and 7 women. Mean age was 47,3years. Purpura was observed in 3 cases, hepatosplenomegaly in 6 cases and peripheral lymph nodes in 3 cases. Hemorrhagic complication was noted in 2 cases. There were an increase of inflammatory indices in all the cases. Eight patients had pancytopenia and 3 had bicytopenia. Six patients developed intravascular dissiminated coagulation. High levels of triglyceridemia was noted in 5 cases and an hyperferritinaemia in all cases. Cytological examination of bone marrow confirmed hemophagocytosis in ten cases. Hemophagocytosis was associated to infectious diseases in 6 cases, there were 2 cases of leishmaniasis, septicemia to E.Coli and staphylococcus aureus and lymph nodes tuberculosis with HIV. We also noted a case of lymphoma, myelodysplasic syndrome, rheumatoid polyarthritis, adult onset still's disease. In one patient, the origin of hemophagocytosis remained indefinite. Visceral leishmaniose were treated by Glucantime®, adult Still's disease by corticosteroids and méthrotrexate®, lymphoma by chemotherapy. In lymph nodes tuberculosis, there were good evolution. Six patients died. CONCLUSION: Hemophagocytic syndrome is a rare and life-threatening disease. Pejorative prognosis requires an early therapy with etiological treatment.

Efficacy of rituximab in refractory polyarteritis nodosa: a case report.

Polyarteritis nodosa (PAN) is a systemic vasculitis affecting medium and small-sized vessels resulting in multiple organ involvement. Refractory PAN requires a different therapeutic approach. We herein report the case of a 42-year-old male presenting a non-virus-related refractory PAN with a favorable outcome on rituximab. He presented significant weight loss, muscle weakness, peripheral axonal neuropathy, and medium-sized cutaneous vessel necrotizing vasculitis. The patient received high-dose corticosteroids and cyclophosphamide with no significant clinical improvement while developing adverse side effects such as hypertension and diabetes. Rituximab was prescribed as an alternative therapy at 1000 mg on day 0 and day 15. This allowed for complete and rapid control of disease activity with regression of cutaneous injury and substantial improvement of neurological symptoms. In conclusion, using chimeric anti-CD20 monoclonal antibodies, such as rituximab, although rarely reported in refractory non-virus-related PAN, may be an effective alternative therapy, as portrayed in our case.

[A leukemoid leucocytosis]. / Une hyperleucocytose « leucémoïde ¼

Leukemoid reaction is a rare paraneoplastic syndrome. It can occur in association with carcinomas, in particular of the lung, gastric and renal. However, its association with sarcoma is infrequent. Leukemoid reaction occuring in patients with uterine sarcoma have not been previously reported. We report the case of a « leukemoid ¼ leucocytosis revealing an uterine sarcoma with fatal evolution.

[An exceptional hepatic tumor]. / Une tumeur hépatique exceptionnelle.

BACKGROUND: Hepatic localization of non Hodgkin's lymphoma is generally secondary. Primary localizations are rare. AIM: To report a rare case of primary hepatic lymphoma particular by its association with dermatopolymyositis. OBSERVATION: A 55-year-old woman with a past medical history of dermatopolymyositis diagnosed one year before presented with abdominal pain and fever. Laboratory tests showed pancytopenia. Radiologic examination revealed multiple hepatic masses. Surgical biopsy revealed a large B cell hepatic lymphoma. No other localizations were found so the diagnosis of primary hepatic lymphoma was retained. The patient died after a few days due to a severe sepsis. CONCLUSION: Primary hepatic lymphoma is a rare tumor with a bad prognosis. Its diagnosis is based on histologic examination. Treatment of these tumors remains non consensual.

[Renal amyloidosis during Behçet's disease. Study of one case]. / Amylose compliquant une maladie de Behçet: a propos d'un nouveau cas.

BACKGROUND: Amyloidosis in Behçet's disease is rare and has a poor outcome. AIM: Report a new case. CASE: We report a case of a 38-year-old Tunisian woman who presented with Behçet's disease and nephrotic syndrome. Renal biopsy showed amyloid deposition consistent with AA type. She had not any associated disease that might be an additional cause of secondary amyloidosis. She was treated by colchicine. After 3 years, proteinuria had disappeared and persisted negative 11 years after the diagnosis. A second renal biopsy showed the persistence of amyloidosis. CONCLUSION: As amyloidosis is one of the prognostic factors affecting survival in Behçet's disease, patients with this disease should be screened for amyloidosis. Administration of colchicine to these patients may be beneficial.

[Chronic disseminated intravascular coagulation caused by aortic dissection]. / Coagulation intravasculaire dissiminee revelant une dissection de l'aorte.

BACKGROUND: Disseminated intravascular coagulation (DIC) is a severe disease. It can be caused by loss of pathology. CASE REPORT: We report the case of chronic aortic dissection discovered during the evaluation of disseminated intravascular coagulation (DIC). This case is characterised by the severity of clinical presentation, challenging diagnosis and difficulty of therapeutic approach. Low dose of heparine may reduce the severity of this situation; but vital prognosis remains obscure. CONCLUSION: aortic dissection is a rare but a severe cause of disseminated intravascular coagulation

Brucellosis, an uncommon cause of acute acalculous cholecystitis: two new cases and concise review.

Acalculous cholecystitis etiologies while numerous, some of them are less-known such as brucellosis. In this report, we elaborate the clinical findings, investigations and management of two female patients presenting acalculous cholecystitis in whom diagnosis of acute brucellosis was retained. Both patients had fever, asthenia and abdominal tenderness. Laboratory results showed evidence of inflammation as well as hepatic cytolysis while cholestasis was noted in one patient. In both cases, ultrasound study and CT confirmed the presence of acalculous cholecystitis. Serology (tube agglutination test) led to the diagnosis of brucellosis. Diagnosis of brucellosis-related acute cholecystitis was established in both cases based on imaging findings as well as serology without resorting to cholecystectomy. Favourable clinical response to specific antibiotic therapy further supported our diagnosis as well as our decision to avoid surgery. Although few cases have been reported, brucellosis must be considered as a cause of acalculous cholecystitis, especially in endemic countries.

Autoimmune haemolytic anaemia in pancreatic adenocarcinoma: a potential paraneoplastic presentation.

While autoimmune haemolytic anaemia (AIHA) is a well-known paraneoplastic syndrome in haematological malignancies, it has been described far less in solid tumours. We hereby report the case of a 61-year-old male patient presenting AIHA related to pancreatic cancer. Investigations excluded infectious, autoimmune and toxic causes of AIHA. CT of the abdomen highlighted the presence of hypodense, infiltrating mass of the tail of the pancreas measuring 70×37×36 mm, compatible with pancreas neoplasm. Histological examination of two associated nodular lesions of the liver showed metastasis of pancreatic adenocarcinoma. The patient was started on corticosteroid without improvement of haemoglobin. Palliative chemotherapy was initiated; this led to significant improvement in haemoglobin comforting our diagnosis. This case illustrates the rare association between AIHA and pancreatic cancer. However, such association cannot be considered before excluding other, more frequent, aetiologies.

[Traumatic and psychosocial complications of falls in the elderly in Tunisia]. / Complications traumatiques et psychosociales des chutes chez le sujet âgé tunisien.

INTRODUCTION: Falls in the elderly are a major health problem due to their traumatic and psychosocial complications which may lead to a loss of autonomy and a state of dependency. This study aims to study the traumatic circumstances and psychosocial consequences of falls in the elderly. METHODS: We conducted a retrospective study of 40 patients aged 65 years and over with a history of at least one fall in the previous year between September 2014 and January 2016. They were enrolled among patients hospitalized or treated on an outpatient basis in the Department of Internal Medicine B in the Hospital Charles Nicolle. Data on circumstances and consequences of falls were collected through a retrospective interview with patients and their entourage about the fall. RESULTS: The average age of fallen patients was 75,7 years, with a female predominance (30F/10M). Precipitating factors were found in 38 patients. Extrinsic factors were found in 78.9% of cases while intrinsic factors in 50% of cases. Extended stay on the ground was reported in 10% of cases. Fractures were more frequent among women (12F/1M), especially involving upper limbs (61.5%). Psychosocial consequences were more frequent among women. Post-fall syndrome was found in 5 patients. CONCLUSION: The correction of the extrinsic and intrinsic precipitating factors of falls and the implementation of educational programs on how elderly should get up from the ground properly after a fall will prevent the risk of a fall as well as fall-related severe consequences.

[Hypercalcemia related to PTH-rP revealing malignant hepatic epithelioid hemangioendothelioma]. / Une hypercalcémie humorale maligne révélant un hémangioendothéliome épithélioïde du foie.

Hypercalcemia caused by tumor production of PTH-rp occurs most often in cases of squamous cell carcinoma of the lung, aerodigestive tract cancer, gynecological cancer and lymphoma. We report an exceptional case of PTH-rp related to a hepatic hemangioendothelioma. A 70 years-old male admitted for deterioration of the general state. The laboratory investigations revealed hypercalcemia, related to tumor production of PTH-rp. Imaging revealed tumoral hepatic lesions. Histopathological study and immunohistochemistry showed diffuse response for CD31 marker, CK20 (+) with CK7 (-) and hepatocyt antigen (-). The diagnosis of PTH-rp related to hepatic hemangioendothelioma was make. The patient died with recurrence of fatal hypercalcemia. Management of patients presenting with humoral hypercalcemia includes a vigorous search for tumor lesions. Elevated PTH-rp can be a bad prognostic factor. In front of tumoral liver lesions, a hepatic epithelioid hemangioendothelioma must be considered. Immunohistochemistry is necessary to make diagnosis.