Tuberculous meningo-encephalitis complicated by hydrocephalus in HIV patient

Hydrocephalus is a serious complication of tuberculous meningoencephalitis in HIV patients. The disease can affect vital and functional prognosis of patients. A 20 years-old woman was admitted for deterioration of her consciousness. She has a history of HIV infection since 3 months. Cerebral imagery showed signs of tuberculous meningoencephalitis. The paient was treated by antituberculous therapy with a good evolution. At the third months of treatment the patient presented roughly alteration of her consciousness and intracranial hypertension. Cerebral scan showed active ventricle hydrocephalous. The patient had ventricle extern derivation and then ventricle peritoneal derivation. Antituberculous and antiretroviral therapies were maintained. The outcome was favourable [follow up of one year]. central nervous system involvement in HIV patient can be observed at any stage of the disease with a consequent mortality and morbidity. central nervous system tuberculosis is observed in 10% of patients who presented an association of HIV-tuberculosis and only in 2% to 5% of tuberculous immunocompetent patients. Hydrocephalous is observed in 32% to 51% of HIV patients associated with tuberculosis meningoencephalitis. Hydrocephalous is a common complication of tuberculous meningoencephalitis witch can worsened the neurological statue of HIV infected patient. An early surgical and medical management was associated with a good prognosis

[Unusual paralysis: due to black widow bite]

The mediterranean black widow spider is a kind of latrodectus mactans tredecimguttatus. It is found in the Mediterranean basin. Its bite cause a rare syndrome called lactrodectism. A Moroccan patient, aged 17 years old, came to the emergency ward with severe pain in the right chest and fever, insect bites scar at the elbow. The evolution was favorable with antibiotics, antihistamines, and intravenous calcium. The discovery by the family in the patient's room of the spider identified type Latrodectus has consolidated the diagnosis of spider bite. Latrodectus tredecimguttatus is a spider that can be responsible of envenomation in humans. Its bite is almost painless. The alpha-neurotoxin protein latrotoxine is implicated in the onset of symptoms, this symptomatology is polymorphic, including a latrodectismica facies, with or without constitutional symptoms, painful symptoms, cardiovascular signs and digestive signs that represent the most common pattern of consulting and most often a source of diagnostic errors. Latrodectism is a source of frequent misdiagnosis, surgical acute abdomen, colic, tetanus, meningitis, psychosis, myocardial infarction of opiate withdrawal syndrome inducing inappropriate treatment, often detrimental to the poisoned patient. This poisoning, although rare, must be known because if can lead to unnecessary therapeutic procedures, and even be potentially fatal for extremely aged people with extreme ages of life

[Pet scan in internal medicine]

The nuclear medicine techniques represent an important role in infections and inflammation's evaluation. 18-fluorode soxyglucose [18F-FDG] is a tracer of glucose metabolism, recently produced in Morocco, which provides functional sensitive and high resolution images thanks to Positron Emission tomography [PET]. The indications of FDG-PET in internal medicine include the diagnosis management of certain inflammatory diseases, vasculitis of large vessels, such as temporal arteritis, especially in its systemic presentation, and Takyasu's arteritis. It is also useful for staging sarcoidosis, for differential diagnosis and the therapeutic's evaluation in multiple myeloma. The 18-FDG PET is the most effective for the diagnosis of paraneoplastic syndromes, or carcinomas of unknown primary. In case of fever of unknown origin, it facilitates the identification of the site of the infection and guides investigations conducting to the confirmation of the diagnosis. All, situations frequently found in internal medicine. This article will focus on the role of 18-FDG PET in the pathology specific to internal medicine. However, large scale prospective studies are needed before incorporating FDG-PET in clinical routine, because it is expensive and not available in our country

[News flow about A, H1N1 influenza]

2009 H1N1 is a new influenza virus causing illness in people. The first cases detected were in Mexico and in the United States in April 2009. This virus is a variant of influenza virus A, coming from triple human restocking, aviaire and porcine. The first cases were discerned in Mexico and in USA joined in April, 2009. In the date of February 17th 2010, 17208 cases of influenza A, H1N1 was confirmed in Africa and including 167 deceases. The virus has an interhuman transmission across the world, probably according to the same mode of transmission as the seasonal virus influenza. The state of pandemic was signaled by the worldwide organization of health on June 11th, 2009 and is spreading from person-to-person worldwide, probably in much the same way that regular seasonal influenza viruses spread. On June 11, 2009, the World Health Organization signaled that a pandemic of 2009 H1N1 flu was underway. H1N1 a virus affect particularly young patient [20-40] at the difference to the seasonal influenza virus. The principal risk factors to the development of serious complications were: the young age, pregnancy and the presence of a chronic medical illness. The main clinical demonstrations of this virus are: fever, evil of throat, tiredness, aches and/or digestive disturbances with type of diarrheas and sometimes vomiting. The treatment consists of the seriousness of this influenza and the necessity of installation of appropriate prophylactic measurements [individual hygiene, vaccination and precautionary antiviral treatment in case of exhibition] to restrict the transmission of this infection and reduce total mortality. The aim of this study is to put a full stop on the clinical aspects, therapeutic measurements and the efficient means of prevention against this influenza

[Management of chronic lymphocytic leukemia]

Lymphoide chronic leukemia [LLC] is characterized by a heterogeneous evolution introduced classficiations around thirty years ago by RAI and Binet, having based on clinical signs and biological parameters allowed of license to differentiate three groups of patients having distinct forecasts. These classifications allowed guiding therapeutic strategy. However, they do not allow predicting the evolution of illness precisely, particularly at the patients having a weak risk. Since a dozen years, the taking care of lymphoide chronic leukemia was transformed by progress accomplished in the understanding of the physiopathology of illness, the identification of new markers with value prognosticates and the advent of new therapeutic tools. The aim of this review is to report, the actualities in the management of lymphoid chronic leukemia

[Reactive macrophage syndrome]

It is also known as hemophagocyticc syndrome, defined as pathology group characterized in common by the proliferation and the accumulation of macrophages in the bone marrow and the lymphoid system, leading to an abnormal phagocytosis of the blood cells and the production of proinflammatory cytokines. It has a non specific clinical picture as well as a perturbed laboratory findings. We differentiate the hereditary primary forms and the secondary related to several etiologies. Its pathophysiology is not yet clear the treatment remains poorly codified. It is a serious like-threatening disease but recent advances in the comprehension of its physiopathologic mechanisms will allow for a better adapted treatment and improve the survival rate of these patients

[Peripheral neuropathies with monoclonal gammopathy of undetermined significance]

The association of peripheral neuropathy and the monoclonal gammopathy of undetermined significance CMGUSD has been frequently reported in 8 to 36% of cases. While the neuropathy associated with IgM-MGUS is well characterized and is often associated with a reactivity of the monoclonal protein with neural antigens, the relationship between the neuropathy and IgG and IgA MGUS is less clear. We report two cases of sensitive-motor chronic poly neuropathies associated with IgG MGUS in the first, and IgM MGUS in the second. Their clinical symptoms are foot numbness, paresthesias, imbalance, and gait ataxia, progress about months. Treatment associate plasma exchange, corticosteroids in combination with immunosuppressant. neuropathies with IgM MGUS tend to be most refractory than IgG MGUS

[Management of bone density abnormalities in inflammatory bowel diseases]

Osteoporosis is a common and life-threatening problem in patient with inflammatory bowel diseases. Its management is so very important and must be systematically investigated. The incomplete comprehension of pathogenesis and physiopathology of osteopenia in IBD is source of big difficulties in the treatment of this abnormality. Many advances had been realized last years in the management of osteopenia of IBD. This paper is a review of the physiopathology of low mineral density in patients with IBD and its implications on treatment

Mycophenolate mofetil in the treatment of systemic discoid lupus erythematosus

The mycophenolate mofetile has been succesfully used for the treatement of several autoimmune skin diseases in a case of a 27 year old fenale patient, who was diagnosed as acute disseminater SLE in may 2002, according to the ARA document revised in 1987. Two years later, she had an intrauterine fetal death of 32 weeks, causing a severe, psychological impact. She complained of a generalised discoid lupus C face, thorax and both upper and lower limbs]. Due to the resistant oral and local hydroxychloroquine and local dapsone treatment, she had cortisonic diabetes, aseptic necrosis of the head of the femur, and macular toxicity caused by antimalarial therapy. The skin lesions was associated with proliferative segmental and focal lupus nephritis. Induction treatment with 29 per day of mycophenolate mofetil associated with corticaltherapy by prenidsone 1 mg/ kg/ id lead to the dissaperance of the skin lessions and porteinurea

Hypercalcemi in elderly patient

Hypercalcemia is not rare among elderly patients. Hyperparathyroidism and neoplasia are the most frequent causes of hypercalcemia in old patients. Symptoms due to hypercalcemia are usually non specific in old subjects, leading to consider easily this diagnosis and to measure plasma calcium level. Biological diagnosis of hypercalcemia is not always obvious in old patients because of frequently decreased plasma albumin levels leading to lower plasma total calcium level. Thus, it is always necessary to calculate plasma total calcium level corrected by albumin. The symptomatic treatment of hypercalcemia rests on the intravenous administration of isotonic saline and the use of the bisphosphonates which currently represent the therapeutic of choice. Specific treatment depends on the etiology. The short-term risk of hypercalcemia is acute hypercalcemia, which may be lifethreatening. The long-term risk of hypercalcemia is renal failure

Articular manifestations associated with HIV infection

During the infection by human immunodeficiency virus, there is dysfunction in the immune system because of the coexistence of immundeficiency and immune hyperactivity, and a disregulated production or activity of cytokines. Some of these mechanisms explain the development of articular manifestations associated with HIV infection Highly active anti retroviral therapy has changed the spectrum of the HIV-associated articular manifestations. New syndromes have emerged. A variety of disorders may be seen. Their prevalence is controversed. Several points remain obscures such as the existence of genetical predisposition for these manifestations, the role played by the anti retroviral therapy and utilisation of immunosuppressors like inhibitors of TNF alpha

[ leptospirosis: clinical, biological and therapeutic study]

The Leptospirosis is an obligatory declared infectious disease, caused by a bacteria type spirochaete

Objectives: Analyse the clinical, biological and therapeutical characteristics of cases of leptospiral infection in the department of the internal medicine at CHU Ibn Sina, Rabat

Patients and Method: It was a retrospective study that begins in january 2000 still décember 2004.The inclusive criterions based on the epidemic circumstances orientated to the leptospirosis and the clinical and biological evokating arguments

Results: Seventeen cases were studied. Average age of the patients is 38 years old [28 years to 64 years] sex ratio of 7, 5 with predominance masculine. Contamination is related to of profession or exposure in a public bath in all the cases. The diagnostic period was 7-8 days. Clinically; icterus appears as a constant symptom, fever founded in 88% of the cases and hepatic cytolysis in 70% of the cases [transaminases are 2 times superior then the normal]. Renal insufficiency and thrombocytopenia are noted respectively in 58, 8% and 47% of the patients On the therapeutic plan; all patients benefited from parenteral rehydration. Thirteen patients benefited from a therapy based on Penicillin G; four patients were treated by Ampicillin parenteraly. One patient had presented with a mucocutaneous allergic reaction from Penicillin G at a 4 of the treatment so he had put on Cyclins. The average duration of hospitalization is 12, 5 days. Evolution was favourable in all patients

Conclusion: The diagnosis of leptospirosis must be evoked in all common cold [acute coryza] accompanied by hepatic cytolysis, renal insufficiency without thrombocytopenia. In the absence of serological proof, the clinical polymorphism of this disease makes the diagnosis sometimes difficult

[Chronic diarrhea with difficult diagnosis during HIV infection]

Diarrhea is a frequent symptom related to HIV infection. It may impose diagnostical and therapeutical problems. We reported an observation of two HIV patients presenting with chronic diarrhea. It concerns two patients, a female aged 43 years and a male of 27 years old who had diarrhea related to HIV-AIDS infection. Parasitological stool analysis and colonoscopy examinations were necessary in the aetiological researches for both of them. The founded aetiology of the first case was a cryptosporidisis associated with cytomegalovirus colitis, while the second case diagnosed as an indetermined origin colitis. The evolution of diarrhea was favourable in the first case by a treatment composed of an association of antiretroviral and Ganciclovir therapy, while only a tritherapy was needed for the second patient. HIV - related chronic diarrhea imposes rigourous parasitological and endoscopical researches in order to get an effective therapy against the eventually opportunist infection

[Laryngeal amyloidosis]

Laryngeal amyloidosis is a rare cause of dysphonia. We report cases of 4 patients with laryngeal amyloidosis diagnosed in internal medicine department in Rabat. It is about 2 female and 2 male patients. The mean age is 53 years. Dysphonia and laryngeal dyspnea were the most frequent symptoms. Laryngeal endoscopy showed pseudotumoral lesion in all cases. The research of other localizations and of plasmocytic proliferation was negative. Two patients had chirurgical treatment and all patients had medical treatment. The outcome was good in the 4 cases. Laryngeal amyloidosis is a rare condition. The prognosis is better than in systemic amyloidosis. However, early diagnosis and appropriate management are essential for good evolution without complication

Le syndrome hypereosinophilique. [a propos de 3 cas]

The hypereosinophilic syndrome is defined by prolonged hypereosinophilia with unknown cause. It's a rare multisystemic pathology of average aged man. It is manifested by multivisceral affections including lungs, nervous system, liver, heart, kidney and skin. But cardiac affection is the most deleterious. We report 3 cases of hypereosinophilic syndrome presented the internal medicine service of the university of Rabat

Macroglobulinemie de waldenstrom [a propos de 10 cas]

Waldenstr 5 g/l and a medullar lymphoid proliferation. Between 1979 and 1997, we studied retrospectively 10 cases of Waldenstr

Association poly arthrite rheumatoide et maladie de Horton. [a propos d'un cas]

Rheumatic symptoms often occur in the course of temporal arteritis. However, the association with rheumatoid arthritis is exceptional. We report the case of a 68 years old lady, who had clinical features of temporal arteritis with biopsy proven lesions, 9 years after the beginning of a rheumatoid arthritis