Pulmonary hypertension and von Recklinghausen's disease: association and therapeutic difficulties

The neurofibromatosis type 1 (NF1) or Von Recklinghausen's disease is a genetic disorder. The café-au-lait spots and neurofibromas are the most common manifestations. Respiratory symptoms are rare in this disease, described as neurofibromas, infiltrative lesions, cysts, bubbles or emphysema. Pulmonary hypertension is rarely reported. It is due to the plexiform lesions in pulmonary arterioles or to parenchymal lung lesions reducing the vascular bed. We report a case of idiopathic precapillary pulmonary hypertension in a young patient with Von Recklinghausen's disease.

[Pulmonary nocardiosis and sarcoidosis]

Infectious complications are rarely observed in the course of sarcoidosis. Only small series or cases reports of infection are described in sarcoidosis. Corticosteroids-induced immune suppression, pulmonary fibrosis and T-CD4 lymphopenia, are often present. Pulmonary nocardiosis is an important cause of opportunistic infection in immunosuppressed patients, and the incidence of this infection is increasing. Pulmonary nocardiosis manifests as an acute, subacute or chronic infection with a marked tendency towards remissions and exacerbations. We report a case of pulmonary nocardiosis in a patient with sarcoidosis followed for pulmonary fibrosis receiving corticosteroids. During the investigation of pyrexia and dyspnea, evidence of Nocardia spp. infection was found in the bronchial secretions. Six months of trimethoprim/sulfamethoxazole therapy ensured further resolution of this pleuropulmonary infection. Pulmonary nocardiosis is exceptional in sarcoidosis and mainly occur, in patients receiving corticosteroids, and with CD4+ T-lymphocytopenia. Sarcoidosis by itself does not appear to be a risk factor of opportunistic infection.

[Nodular liver lesions with fever in a Moroccan man: hepatic brucelloma]

Hepatic brucelloma is an exceptional localization in brucellosis. The purpose of this report is to describe an uncommon case involving a 42-year-old man hospitalized for febrile hepatic cytolysis. Diagnosis was established based on positive rose bengal test results, positive blood culture, hypoechogenic masses on ultrasound, and hypodense enhancing masses on CT scan. Hepatic brucelloma is a focal suppurative lesion occurring after undetected acute brucellosis or undertreated brucellosis. Diagnosis is based on the association of imaging showing characteristic features (hepatic calcifications) and on positive blood culture and serology. First-line treatment should consist of doxycyclin and rifampicin for 2 to 12 months. If medical treatment fails, surgical drainage should be performed.

[Primary gastric lymphoma: a retrospective series of 35 cases]

BACKGROUND

Primary gastric non Hodgkin's lymphoma (PGNHL) is the most common site of extranodal malignant lymphoma. It is a rare subtype of malignancy, for which no consensus exists about treatment.

AIM

The purpose of This paper was to assess the managemnt of PGNHL.

METHODS

Between January 1992 and December 2001, 35 patients were retrospectively evaluated.

RESULTS

Of the 35 patients, with a mean age of 44 years old Signs and symptoms are unspecific. 20 (57.1%) were in stage IE/IIE1. 15 patients (42.8%) were in stage IIE2,IIIE,IVE. These patients were treated with primary surgery with or without chemotherapy (11; 31.4%); primary chemotherapy (CT) alone with surgery in one patient (21; 60%) and three patients with gastric MALT lymphoma were treated by Helicobacter pylori eradication. The 5 year survival rates of the 35 patients are 62, 86%. There was no significant difference in the 5 year survival rate between the patients with low grade lymphoma and the patients with large grade lymphoma (75% versus 60%, P = 0.467). The 5-year survival rates for stage I/IIE1 and IIE2/III/IV patients were 80%, 53.3% respectively (p < 0.144). Of the 11 primary surgical groups with or without chemotherapy, the 5 year survival rate is 90.9%. Of the 21 patients who received CT, alone or combined with surgery, the survival rate is 52.4%. There was significant difference between the two groups (P = 0.05). Of the 3 patients with low-grade mucosa-associated lymphoid tissue (MALT) lymphoma with only oral anti-Helicobacter pylori regimen remained disease-free after a median follow-up of two years.

CONCLUSIONS

This study suggested that primary surgical resection may be important factor predicting the long-term survival of patients with primary gastric NHL. H. pylori eradication therapy was an effective first-line treatment for patients with gastric MALT lymphoma.

[Hodgkin's disease presenting with spinal cord compression]

INTRODUCTION

Hematological neoplasms may be complicated by signs of neurological compression. Most cases reported in the literature have described advanced-stage non-Hodgkin lymphomas. We report a case of spinal cord compression revealing an isolated vertebral localization of Hodgkin lymphoma.

CASE REPORT

Magnetic resonance imaging of the thoracic spine in a 54-year-old man who presented with spastic paraplegia revealed a vertebral and extradural mass. After laminectomy, histology and immunohistochemistry showed Hodgkin's disease. Post-operative staging did not reveal any other localization. The patient responded favorably after decompressive surgery and ABVD regimen.

CONCLUSION

Spinal cord compression is a rare complication of Hodgkin's disease, occurring in only 5p.cent of cases, usually in the setting of progressive, advanced disease. As the initial symptom of Hodgkin's disease, it is extremely rare, with only a few cases reported in the literature. Significant results may be obtained with decompressive surgery and chemotherapy when the disease is promptly diagnosed. Spinal cord compression by primary Hodgkin's disease is a very infrequent situation. We urge this diagnosis be considered in all patients presenting with spinal cord compression attributed to malignancy.

[Silent myocardial infarction and antiphospholipid antibody syndrome]

We describe a case of 18-year-old woman followed for 3 years for systemic lupus erythematosis (SLE) complicated of a nephrectomy. Having like only factor of cardiovascular risk a balanced arterial hypertension. The patient was hospitalized because of choreo-athetosic's movement. We discovered fortuitously during this hospitalization an inferior myocardial necrosis as well as a mitral regurgitation. Coronary angiography was normal and the ventriculography showed an akinesy in the inferior territory. Biology made it possible to pose the diagnosis of antiphospholipid antibody syndrome (APS) on (SLE). We suppose that surgery started myocardial necrosis and underline through this case interest of early identification and appropriate treatment of APS as well as a narrow monitoring particularly in young patients candidates to surgery.

[Fluoxetine and inappropriate antidiuretic hormone secretion in elderly patients: a case report]

Elderly people are more likely to be affected by hyponatremia related to the use of specific inhibitors of serotonin recaptation. Doctors who treat old patients should be aware of this adverse effect which can be serious but is reversible. The observation of a new case of SIADH induced by fluoxetine in a 65 years-old patient is the opportunity to point out the main aspects of this pathological entity which must be suspected in case with hyponatraemia, blood hypoosmolality and high urinary osmolarity.

Hyperplasie angiolymphoïde à éosinophiles

INTRODUCTION

Angiolymphoid hyperplasia with eosinophilia is a rare affection.

CASE REPORT

A 36 years-old woman presented an angiolymphoid hyperplasia with eosinophilia manifesting by erythematous nodular lesions on the face and the forearms, severe neuropathy, visual loss and eosinophilia. Corticosteroids, immunosuppressive drugs and interferon-alpha were unsuccessful.

DISCUSSION

Angiolymphoid hyperplasia with eosinophilia is a dermatological disease with possible systemic features. Differential diagnosis with Kimura disease is based on clinical presentation and histological findings. Etiopathology remains unknown and the treatment is not codified.

[Isolated pseudo-tumoral tuberculosis of the spleen. A case report]

INTRODUCTION

The tuberculosis isolated tumoral spleen is rare, even in the countries to strong tubercular endemic.

EXEGESIS

From an observation, concerning an important, tumoral and isolated splenomegaly in 48-year-old-man. The authors put the accent on his tumorous variety by the clinic, the imagery and on macroscopic appearance of the operative piece. Are discussed the isolated character, the way of dissemination, the site of initial infestation and the deceitful character of haematological manifestations. A splenectomy to diagnostic and therapeutic goal have been realised, associated to the chemotherapy.

CONCLUSION

This is an expression of the profound organ's tuberculosis rich on endothelial reticular system. It's mean a singular topography of the bacillary lesion and a great distribution of the tubercular affect.

[Non-Hodgkin's malignant lymhoma of mental soft tissue: a case report]

Non-Hodgkin's malignant lymphoma is rarely located in the soft tissue of the chin making diagnosis difficult. Clinical signs are non-specific: progressive weight loss, asthenia, fever, an inflammatory tumefaction unresponsive to medical treatment. Imaging shows a homogeneous tumefaction of the soft tissues. Pathology and immunohistochemistry establish the diagnosis.

[Cardiothyrotoxicosis in the young adult in Basedow disease: report of 30 cases]

The authors report on 30 cases of cardiothyrotoxicosis in the young adult with Basedow's disease. Cardiac arrhythmia represented the most frequent clinical form of dysfunction, mainly atrial fibrillation. Conductive disorders came second, with seven cases of first-degree atrioventricular block [AVB], one case of second-degree AVB, and two cases of sinusoidal bradycardia. Three cases of ballooning of the mitral valve were detected by echocardiography. Myocardial hypertrophy was found in one case. The authors discuss the various physiopathological hypotheses regarding conduction and myocardial hypertrophy anomalies. No cases of severe cardiac insufficiency or coronaropathy were noted, which is explained by the absence of cardiopathic antecedents and the young age of the patient population. Treatment is more complicated in the case of a preexisting cardiac event.

[Sinus dysfunction in Basedow's disease. A case report]

INTRODUCTION AND EXEGESIS: The authors report a case of sinus node dysfunction that occurred in a 22-year-old patient with Graves' disease and disappeared after thyroidectomy.

CONCLUSION

Bradycardia is uncommon in hyperthyroidism, the sinus node dysfunction would be due to thyrotoxicity-related myocarditis.

[Hyperthyroidism and atrioventricular block. Pathogenic hypothesis. Apropos of a case and review of the literature]

The authors report the case of a 26-year old male patient who had Graves' disease with a first degree atrioventricular block (AVB) and intermittent episodes of a second degree AVB of the Lucciani-Wenckebach type. These disorders of conduction had features characteristic of a nodal block and disappeared after treatment of the hyperthyroidism. The pathogenesis of atrioventricular conduction disorders in hyperthyroidism remains controverted. The authors put forward the following hypothesis: under the influence of thyroid hormones in excessive amounts, the autonomic nervous system would act by reciprocal excitation and exacerbate a patent or latent hypervagotonia which was pre-existent to the hyperthyroidism. This hypothesis needs to be tested by intracardiac electrophysiological studies with atrial stimulation.