Thrombose veineuse extensive du membre supérieur après la vaccination anti-COVID-19

Introduction

Les événements indésirables après la vaccination COVID-19 ont été une grande préoccupation au monde entier, faits majoritairement de réactions locales, syndrome pseudo-grippal, avec quelques cas de syndrome de Guillain-Barré, de myocardite et/ou de péricardite. En outre, de rares cas de thrombocytopénie thrombotique immunitaire induite par le vaccin (VITT) et de thromboses cérébrales ont été signalés surtout avec les vaccins à vecteur adénoviral. Nous rapportons un cas d’une thrombose du membre supérieur étendue à la veine axillaire, sous-clavière et jugulaire interne après vaccination COVID-19.

Observation

Patiente de 69 ans, sans antécédents pathologiques particuliers, sans facteurs de risque thrombogènes évidents, ayant présenté 3 semaines après sa première dose de vaccin AstraZeneca COVID-19 (ChAdOx1) une tuméfaction du membre supérieur gauche, au site de la vaccination, dure, chaude, douloureuse, sans signes infectieux. L’écho-Doppler veineux a objectivé une thrombophlébite superficielle et profonde du membre supérieur gauche étendue intéressant les veines radiales, cubitales, brachiales, axillaire, sous-clavière et jugulaire interne. Le bilan étiologique notamment infectieux, néoplasique, immunologique et de thrombophilie était négatif. Il n’y avait pas de thrombopénie. Sur le plan thérapeutique, la patiente a été mise sous héparinothérapie à dose curative avec relais par anti-vitamine K. L’évolution était favorable avec disparition de la tuméfaction du membre supérieur gauche.

Conclusion

La TVP aiguë après le vaccin AstraZeneca COVID-19 (ChAdOx1) est liée à l’activation de la cascade inflammatoire et à la coagulopathie. Il s’agit plutôt de thromboses cérébrales, abdominales ou d’embolies pulmonaires. La localisation au membre supérieur est exceptionnelle. Nous en discutons les mécanismes possibles.

[Stiff person syndrome associated with dermatitis herpetiformis: a case report]

Le syndrome de la personne raide (SPR) est une maladie rare affectant le système nerveux central et qui peut être d´origine auto-immune, paranéoplasique ou idiopathique. Sa présentation classique typique est caractérisée par une rigidité progressive du tronc et des membres, associée à des spasmes. Le diagnostic est soutenu par l'existence d'une activité musculaire continue et spontanée en détection à l'électroneuromyogramme, la présence d'anticorps anti-acide glutamique décarboxylase (anti-GAD) sériques, et une réponse aux benzodiazépines. Nous rapportons le cas d'un patient de 46 ans ayant une forme classique de syndrome de la personne raide auto-immune associée à une dermatite herpétiforme.

Necrotizing Fasciitis of the Breast Underlying an Autoimmune Disease

Necrotizing fasciitis is a serious soft tissue infection that causes necrosis of the subcutaneous tissues and the muscle fascia. It is associated with a high mortality rate of around 25%. Necrotizing fasciitis of the breast is a rare entity. It is a rapidly progressive life-threatening condition which can lead to sepsis with multiple organ failure. We describe a case of necrotizing fasciitis of the right breast in a 48-year-old patient diagnosed with systemic sclerosis-rheumatoid arthritis overlap syndrome.

LEARNING POINTS

Necrotizing fasciitis of the breast is a very challenging diagnosis due to its rarity and similarity with simple breast infection.It is a life-threatening condition which can lead to systemic shock and multiple organ dysfunction syndrome and death.It may occur in patients with rheumatic diseases treated with corticosteroids and immunosuppressant drugs.

[Drug-induced toxidermia in a patient receiving hydroxychloroquine as systemic therapy for primary Gougerot-Sjögren syndrome: a case report]

Nous rapportons un cas d´exanthème maculo-papuleux apparu après une semaine de prise de l´hydroxychloroquine 400mg prescrite pour une atteinte articulaire d´un syndrome de Gougerot-Sjögren primaire chez une patiente de 41 ans. Cette dernière était suivie pour une lésion glomérulaire minime idiopathique depuis plus d´un an, traitée efficacement avec la corticothérapie. Les exanthèmes maculo-papuleux ont régressé après avoir reçu l´hydrocortisone, la desloratadine et l´arrêt immédiat de l´hydroxychloroquine. Notre cas reflète l´importance d´insister sur la prescription à faible dose de l´hydroxychloroquine chez les sujets avec des pathologies préexistantes rénales et aussi l´intérêt de sensibiliser et d´éduquer les patients des effets secondaires de l´hydroxychloroquine.

Myasthenia Gravis Revealing Hodgkin's Lymphoma

Introduction

Myasthenia gravis is a rare autoimmune disease caused by autoantibodies directed against the synapses of the neuromuscular junction.

Patient and methods

We report the case of a young patient with myasthenia gravis associated with Hodgkin's lymphoma.

Results

A 22-year-old patient presented with a 2-month history of severe weakness associated with muscle fatigability and intermittent ptosis without dysphonia or respiratory signs. Clinical examination revealed generalized myasthenia. The EMG did not show post-synaptic block, and anti-acetylcholine receptor antibodies were elevated at 3 nmol/l (normal ≤0.3 nmol/l). CT of the thorax showed an anterior medial mass. Immunohistochemistry of the mass revealed mixed cellularity Hodgkin's lymphoma.

Conclusion

The association of lymphomas with myasthenia gravis has been rarely reported.

LEARNING POINTS

Myasthenia gravis is an autoimmune disease of the neuromuscular junction and can be associated with malignant haemopathy.The coexistence of myasthenia and Hodgkin's lymphoma is very rare.This association is a therapeutic challenge.

[Extensive digital gangrene revealing late-onset systemic lupus erythematosus]

INTRODUCTION

Late-onset systemic lupus erythematosus represents a specific sub-group of the disorder, beginning after 50 years of age. The incidence is rarer and the course of the disease is considered to be more benign. Digital gangrene is an uncommon complication of systemic lupus erythematosus reported especially among middle-aged patients with long disease duration.

OBSERVATION

We report a 53-year-old man, who presented with systemic lupus erythematosus revealed by an extensive digital gangrene.

CONCLUSION

Digital gangrene is a rare complication of late onset systemic lupus erythematosus. Clinicians should be aware of this complication in order to initiate early and aggressive treatment.

Pernicious anemia in a young man with systemic lupus erythematosus

Association of pernicious anemia and systemic lupus erythematosus is rare, although both diseases are autoimmune origin. We describe the case of a 40-year old man with systemic lupus erythematosus (SLE) who developed pernicious anemia. The cobalamin deficiency was revealed by macrocytic pancytopenia. After 1 month of vitamin B12 treatment, hemoglobin and white blood cell count remain normal but thrombocytopenia persists and was considered as immunologic from SLE origin requiring corticosteroids. Lupus (2007) 16, 827—829.

[Drug induced interstitial lung disease in systemic diseases]

Immunosuppressants and immunomodulators are designed to regulate excessive immune response responsible for inflammatory lesions and are prescribed more and more in internal medicine. These drugs are known for their efficiency but with a significant toxicity including interstitial lung disease (ILD). Some factors liable to pulmonary toxicity include advanced age, genetic polymorphism and the existence of prior pulmonary disease. Cytotoxicity and hypersensitivity are the main mechanisms of pulmonary toxicity. There is no universal classification of drug induced-lung disease. Theoretically, drugs may be responsible for all histological aspects of ILD. Methotrexate is the most well-known drug as a provider of ILD with a prevalence of 0.3 to 11.6%. Some cases of ILD have also been reported with the new biologics used in systemic diseases. The diagnostic approach to the suspicion of drug ILD is to eliminate non-medicinal causes of pneumonia including infections and tumors before exploring the clinical symptomatology and the results of imaging and bronchoalveolar lavage cell profile. The analysis of the clinical symptomatology check the compatibility of the chronology of clinical and/or radiological pneumonia with the medication suspected. Subsequently, data from the clinical case are compared with those of the literature. Treatment involves stopping the suspected drug. The use of corticosteroids may be required in case of signs of severity or a lingering evolution.

Periorbital edema as initial manifestation of chronic cutaneous lupus erythematosus

Periorbital edema occurs frequently in dermatomyositis, but it has rarely been noted in systemic systemic lupus erythematosus. We describe a patient who developed bilateral periorbital edema and erythema as the sole manifestation of systemic lupus erythematosus.

A migraine as initial presentation of celiac disease

Celiac disease (CD), also known as gluten-sensitive enteropathy, is a prevalent auto-immune disorder. The silent form of CD seems to be more frequent than expected. CD has been associated with neurologic and psychiatric disorders, notably cerebellar ataxia, peripheral neuropathy, epilepsy, dementia and depression. Migraine is a rare complication of CD. We report a case of CD revealed by a migraine. Apparently no case of celiac disease revealed by migraine has been reported in the literature.

[Spontaneous Achilles tendon rupture as early manifestation of systemic lupus erythematosus]

Spontaneous tendon rupture is rare in the course of systemic lupus erythematosus (SLE). Its incidence rate remains unknown. The pathogenesis of this manifestation is complex and poorly understood. We report a 39-year-old woman who presented with a spontaneous Achilles tendon rupture as the presenting presentation of SLE, before any corticosteroid therapy. All the patients previously published were receiving corticosteroids and reported in some an associated traumatism. Risk factors are prolonged disease duration, chronic therapy with corticosteroids, deforming arthropathy of the hands, and inactive disease.