[Extrarespiratory manifestations of Mycoplasma pneumoniae: a case report]

Extrapulmonary manifestations of Mycoplasma pneumoniae are sometimes severe and may even be life-threatening. A 10-year-old patient was hospitalized due to a flu-like illness lasting 48 h with impaired general condition, after an extended stay in Africa. There was an inflammatory syndrome associated with hyponatremia, but malaria was negative. A triple antibiotic therapy with ceftriaxone, amikacin, and josamycin was started. The progression was marked by the appearance of hypoxemia pneumoniae associated with extrarespiratory manifestations. He initially presented with acute polyradiculoneuropathy, followed by thrombotic events associated with polyserositis, polyarthritis, a maculopapular rash, and then a hemophagocytic syndrome. Bacteriological samples isolated M. pneumoniae in nasopharyngeal secretions with a positive serology. The appropriate antibiotic therapy associated with corticosteroids and immunoglobulins led to clinical improvement and the patient progressed toward complete recovery. The pathogenesis of M. pneumoniae infection remains largely unknown. However, two main categories have been proposed. The lung injury is caused by the invasion of the respiratory epithelium, whereas the extrarespiratory manifestations are probably due to immunological disorders. The knowledge of extrarespiratory manifestations and their pathomechanisms allows further adjustments to therapeutic management.

Cas de choléra d'importation en France, été 2005. A. Tarantola pour les groupes de gestion des incidents

Cholera is a bacterial infection, which causes digestive symptoms and massive diarrhoea. It may lead to dehydration and death if appropriate medical management is not rapidly initiated. Most cases of infection by choleric vibrio, however, remain symptom-free or may mimic common gastroenteritis. A review of two cases of imported cholera in France in the summer of 2005 and the community- and hospital-based investigation, which they triggered, enabled the incident management teams to assess risks of transmission. There were no secondary cases among 58 hospital contacts and 15 family contacts of the cases. Clinicians will find a discussion of possible clinical presentations and the risk of secondary transmission, in the context of progressing epidemics in countries, which have maintained close ties with France.

[Neonatal nonbacterial thrombotic endocarditis]

Nonbacterial thrombotic endocarditis is not widely known in neonates.

CASE REPORTS

We report three new cases which illustrate some specific aspects of this pathology. Respiratory distress with severe pulmonary hypertension, systemic hypotension and disseminated intravascular coagulopathy in a full-term newborn were characteristic findings.

CONCLUSION

An early echocardiography should lead to accurate diagnosis. Hypoxemia and genetic factors could be determining factors in its pathogenesis.

[Radiotherapy for a massive hepatic hemangioma in a six-week-old infant]

We report the case of a six-week-old baby who underwent irradiation for a giant hepatic hemangioma. After medical treatment including corticosteroids and interferon, no response was observed. She progressed to respiratory failure, requiring the use of mechanical ventilation. An emergency radiation therapy of the liver was decided. We observed a rapid improvement of the child, with the recovery of autonomous breathing without mechanical ventilation and a normalization of cardiac functions. Two months later, a partial left hepatic embolization was needed due to a progression of a localized blood flow. Six months later, she finally came back home. Cardiac output was normal and hepatomegaly began to regress. One year later, ponderal status is satisfactory, and it remains a localized hepatic right lobe hypertrophy without functional consequence.

Abdominal lymphatic dysplasia and 22q11 microdeletion

We report the case of a child with 22q11 microdeletion who presented with abdominal lymphatic dysplasia resulting in exsudative enteropathy. This primitive and localized lymphatic malformation is consistent with the vascular theory in the velocardiofacial syndrome.